The Usefulness of the C 2 HEST Risk Score in Predicting Clinical Outcomes among Hospitalized Subjects with COVID-19 and Coronary Artery Disease.

Background: Even though coronary artery disease (CAD) is considered an independent risk factor of an unfavorable outcome of SARS-CoV-2-infection, the clinical course of COVID-19 in subjects with CAD is heterogeneous, ranging from clinically asymptomatic to fatal cases. Since the individual C ₂ HEST components are similar to the COVID-19 risk factors, we evaluated its predictive value in CAD subjects.
Materials and Methods: In total, 2183 patients hospitalized due to confirmed COVID-19 were enrolled onto this study consecutively. Based on past medical history, subjects were assigned to one of two of the study arms ( CAD vs. non-CAD ) and allocated to different risk strata, based on the C ₂ HEST score.
Results: The CAD cohort included 228 subjects, while the non-CAD cohort consisted of 1956 patients. In-hospital , 3-month and 6-month mortality was highest in the high-risk C ₂ HEST stratum in the CAD cohort, reaching 43.06%, 56.25% and 65.89%, respectively, whereas in the non-CAD cohort in the high-risk stratum, it reached: 26.92%, 50.77% and 64.55%. Significant differences in mortality between the C ₂ HEST stratum in the CAD arm were observed in post hoc analysis only for medium- vs. high-risk strata. The C ₂ HEST score in the CAD cohort could predict hypovolemic shock, pneumonia and acute heart failure during hospitalization, whereas in the non-CAD cohort, it could predict cardiovascular events (myocardial injury, acute heart failure, myocardial infract, carcinogenic shock), pneumonia, acute liver dysfunction and renal injury as well as bleedings.
Conclusions: The C ₂ HEST score is a simple, easy-to-apply tool which might be useful in risk stratification, preferably in non-CAD subjects admitted to hospital due to COVID-19.