ACE-I AND ARBS DO NOT INFLUENCE THE CHEST CT PRESENTATION AND 1-YEAR SURVIVAL OF COVID-19 PATIENTS: ITALIAN MULTICENTER REGISTRY

Background:

Despite data have shown no clinical impact of therapy with ACE-I or ARBs on COVID-19, these drugs are often discontinued upon hospitalization or diagnosis. Aim of this study was to evaluate the effects of cardiovascular risk factors (CVRF) and prior outpatient therapy with RAAS inhibitors on the chest CT severity score performed within 24 hours of diagnosis of SARS-CoV-2 infection (before stopping medications or starting specific therapy for COVID-19) and on 1-year survival.

Methods:

This is a multicenter, prospective, observational study. All admitted patients diagnosed with SARS-CoV-2 infection who performed chest CT within 24 hours of arrival were consecutively enrolled from March 1 to June 1, 2020. A severity score was attributed to Chest CT by two radiologists in blind to the patient's clinical information and a cut-off value of 19.5 was considered to define severe radiological pneumonia. A 1-year telephone follow-up was performed in order to evaluate the determinants of 1-year survival.

Results:

590 patients with a mean age of 63±14 years were included. 73 (12.4%) patients were treated with ACE-I, 85 (14.4%) with ARBs and 62 (10.5%) with CCB. Cox regression analysis showed that male gender [OR: 1.4; CI 95% from 1.02 to 2.07; p = 0.035], diabetes [OR: 1.6; CI 95% from 1.03 to 2.7; p = 0.037], age [OR: 1.02; CI 95% from 1.008 to 1.033; p = 0.001] and obesity [OR: 3.04; CI 95% from 1.3 to 6.7; p < 0.001] were independently associated with a severe CT score. Of note, while prior outpatient therapy with ACE-I and ARBs was not independently associated with severe CT score, therapy with CCB was independently associated with a severe CT score (OR: 1.9, CI 95% from 1.05 to 3.4, p=0.033). Severe chest CT severity score [OR: 1.05; CI 95% from 1.02 to 1.08; p < 0.001], P/F ratio [OR: 0.998; CI 95% from 0.994 to 0.998; p < 0.001] and older age [OR: 1.06; CI 95% from 1.03 to 1.1; p < 0.001] were independently associated with mortality at 1-year follow-up. Neither ACE-I, ARBs and CCB were associated with mortality at 1 year follow-up.

Conclusion:

ACE-I and ARBs do not influence the chest CT presentation of COVID-19 patients at the time of diagnosis. Furthermore, ACE-I and ARBs do not influence 1-year survival of COVID-19 survivors.