Background Throughout the surge of the COVID-19 pandemic high rate of chronic diseases have been reported, including respiratory diseases and cardiovascular diseases. The prevalence of coronary artery disease has remained high throughout the COVID-19 pandemic, which also draws great concern towards it. This study seeks to provide a pooled estimate of the burden of coronary artery disease in COVID-19. Objective To estimate the overall prevalence of coronary artery disease among COVID-19 patients. Data Sources In this systematic review and meta-analysis, an extensive literature search was conducted in PubMed, Scopus, Embase, EBSCO ,Web of Science, Cochrane,Proquest and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN). References fo eligible articles, forward citation tracking, and expert opinion were used to identify other relevant articles. All published articles until 13 April 2023 were assessed as per the PROSPERO registration protocol (CRD42022367501). Study Selection, Data Extraction, and Synthesis Primary studies that reported coronary artery  disease among COVID-19 patients were included. The characteristics of the study and information on the number of cases of coronary artery disease were extracted from the included studies. Individual study estimates were pooled using the random intercept logistic regression model. The heterogeneity between the selected studies was assessed using the I2 statistic, tau, tau-squared, Cochran’s Q. Prediction interval was used to identify the range into which future studies are expected to fall. Subgroup analysis based on geography (continent) was done to reduce heterogeneity. Publication bias was analyzed using doi plot and LFK index. The risk of bias in the studies was assessed as per the tools proposed by the National Institute of Health.   Main outcomes The primary outcome was the pooled prevalence of coronary artery disease among COVID-19 patients within the examined population. ­ Results 510 records were initially retrieved from electronic databases in addition to other sources like reference screening. 33 studies with 40,064 COVID-19 patients were included for quantitative synthesis. The prevalence of coronary artery disease among COVID-19 patients was 15.24% (95% CI: 11.41% - 20.06%). The prediction interval ranged from 2.49% to 55.90%. The studies were highly heterogeneous (tau-sqaured of 0.89), and subgroup analysis significantly reduced it (test of moderators: Q = 14.77, df=2, P=.002). Europe reported the highest prevalence [21.70% (14.80% - 30.65%)], and Asia has the least prevalence [10.07% (6.55% - 15.19%)]. Meta-regression for sample size was not significant (P=.11). A symmetric doi plot and an LFK index of 0.57 revealed no evidence of publication bias or small-study effects. Conclusion The burden of coronary artery disease has been considerable, varying with geography. and further research in this area is needed. Routine cardiac screening and assessment of COVID-19 patients can help uncover undiagnosed cases, and better optimise the management of all COVID-19 patients.

The authors have declared no competing interest.

Yes, Naushaba Akhtar received Indian Council of Medical Research – Senior Research Fellow award [CTU/Fellowship/03/2022-ECD-II - 5th May 2022] https://main.icmr.nic.in/ No, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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