Relationship Between Azithromycin and Cardiovascular Outcomes in Unvaccinated Patients With COVID-19 and Preexisting Cardiovascular Disease
Por:
Bergami, M, Manfrini, O, Nava, S, Caramori, G, Yoon, J, Badimon, L, Cenko, E, David, A, Demiri, I, Dorobantu, M, Fabin, N, Gheorghe-Fronea, O, Jankovic, R, Kedev, S, Ladjevic, N, Lasica, R, Loncar, G, Mancuso, G, Mendieta, G, Milicic, D, Mjehovic, P, Pasalic, M, Petrovic, M, Poposka, L, Scarpone, M, Stefanovic, M, van der Schaar, M, Vasiljevic, Z, Vavlukis, M, Pittao, MLV, Vukomanovic, V, Zdravkovic, M, Bugiardini, R
Publicada:
18 jul 2023
Ahead of Print:
14 jul 2023
Resumen:
Background Empiric antimicrobial therapy with azithromycin is highly used in patients admitted to the hospital with COVID-19, despite prior research suggesting that azithromycin may be associated with increased risk of cardiovascular events.Methods and Results This study was conducted using data from the ISACS-COVID-19 (International Survey of Acute Coronavirus Syndromes-COVID-19) registry. Patients with a confirmed diagnosis of SARS-CoV-2 infection were eligible for inclusion. The study included 793 patients exposed to azithromycin within 24 hours from hospital admission and 2141 patients who received only standard care. The primary exposure was cardiovascular disease (CVD). Main outcome measures were 30-day mortality and acute heart failure (AHF). Among 2934 patients, 1066 (36.4%) had preexisting CVD. A total of 617 (21.0%) died, and 253 (8.6%) had AHF. Azithromycin therapy was consistently associated with an increased risk of AHF in patients with preexisting CVD (risk ratio [RR], 1.48 [95% CI, 1.06-2.06]). Receiving azithromycin versus standard care was not significantly associated with death (RR, 0.94 [95% CI, 0.69-1.28]). By contrast, we found significantly reduced odds of death (RR, 0.57 [95% CI, 0.42-0.79]) and no significant increase in AHF (RR, 1.23 [95% CI, 0.75-2.04]) in patients without prior CVD. The relative risks of death from the 2 subgroups were significantly different from each other (P-interaction=0.01). Statistically significant association was observed between AHF and death (odds ratio, 2.28 [95% CI, 1.34-3.90]).Conclusions These findings suggest that azithromycin use in patients with COVID-19 and prior history of CVD is significantly associated with an increased risk of AHF and all-cause 30-day mortality.
Filiaciones:
Bergami, M:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
Manfrini, O:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
IRCCS Azienda Osped Univ Bologna, St Orsola Hosp, Bologna, Italy
Nava, S:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
IRCCS Azienda Osped Univ Bologna, Resp & Crit Care Unit, Bologna, Italy
Caramori, G:
Univ Messina, Pneumol, Dipartimento Sci Biomed Odontoiatr & Immagini Mor, Messina, Italy
Yoon, J:
Google Cloud AI, Sunnyvale, CA USA
Badimon, L:
Hosp Santa Creu & Sant Pau, Inst Carlos III, Cardiovasc Res Program ICCC, IR IIB St Pau, Barcelona, Spain
Cenko, E:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
David, A:
Univ Messina, Dept Human Pathol Adult & Evolut Age Gaetano Barr, Div Anesthesia & Crit Care, Messina, Italy
Demiri, I:
Univ Ss Cyril & Methodius, Univ Clin Infect Dis, Skopje, North Macedonia
Dorobantu, M:
Carol Davila Univ Med & Pharm, Bucharest, Romania
Fabin, N:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
Gheorghe-Fronea, O:
Carol Davila Univ Med & Pharm, Bucharest, Romania
Jankovic, R:
Clin Ctr Nis, Nish, Serbia
Kedev, S:
Univ Clin Cardiol, Skopje, North Macedonia
Ss Cyril & Methodius Univ Skopje, Fac Med, Skopje, North Macedonia
Ladjevic, N:
Univ Belgrade, Univ Clin Ctr Serbia, Fac Med, Belgrade, Serbia
Lasica, R:
Univ Belgrade, Clin Ctr Serbia, Belgrade, Serbia
Loncar, G:
Inst Cardiovasc Dis Dedinje, Belgrade, Serbia
Mancuso, G:
Univ Messina, Dept Human Pathol, Med Microbiol, Messina, Italy
Mendieta, G:
Ctr Nacl Invest Cardiovasc Carlos III CNIC, Madrid, Spain
Hosp Clin Barcelona, Inst Clin Cardiovasc, Serv Cardiol, Barcelona, Spain
Univ Zagreb, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia
Milicic, D:
Univ Novi Sad, Inst Cardiovasc Dis Vojvodina, Fac Med Novi Sad, Novi Sad, Serbia
Mjehovic, P:
Univ Novi Sad, Inst Cardiovasc Dis Vojvodina, Fac Med Novi Sad, Novi Sad, Serbia
Pasalic, M:
Univ Novi Sad, Inst Cardiovasc Dis Vojvodina, Fac Med Novi Sad, Novi Sad, Serbia
Petrovic, M:
Univ Calif Los Angeles, Dept Elect & Comp Engn, Los Angeles, CA USA
Poposka, L:
Univ Clin Cardiol, Skopje, North Macedonia
Ss Cyril & Methodius Univ Skopje, Fac Med, Skopje, North Macedonia
Scarpone, M:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
Stefanovic, M:
Univ Ss Cyril & Methodius, Univ Clin Infect Dis, Skopje, North Macedonia
van der Schaar, M:
Univ Cambridge, Cambridge Ctr Artificial Intelligence Med, Dept Appl Math & Theoret Phys, Cambridge, England
Univ Cambridge, Dept Populat Hlth, Cambridge, England
Univ Belgrade, Med Fac, Belgrade, Serbia
Vasiljevic, Z:
Clin Hosp Ctr Dragisa Misovi, Belgrade, Serbia
Vavlukis, M:
Univ Clin Cardiol, Skopje, North Macedonia
Ss Cyril & Methodius Univ Skopje, Fac Med, Skopje, North Macedonia
Pittao, MLV:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
IRCCS Azienda Osped Univ Bologna, Resp & Crit Care Unit, Bologna, Italy
Vukomanovic, V:
Univ Belgrade, Clin Hosp Ctr Bezanijska kosa, Fac Med, Belgrade, Serbia
Zdravkovic, M:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain
Bugiardini, R:
Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
Green Published, gold, All Open Access, Gold, Green
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