EBioMedicine · 2025
Long-term outcomes of patients with pre-existing coronary artery disease after SARS-CoV-2 infection.
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Hadidchi Roham, Lee Porsche, Qiu Shawn, Changela Sagar, Henry Sonya, Duong Tim Q
Аннотация
BACKGROUND: The long-term outcomes of patients with pre-existing coronary artery disease (CAD) after SARS-CoV-2 infection are unknown.
METHODS: Patients with pre-existing CAD were classified as COVID+ or COVID- based on the polymerase-chain-reaction test in the Montefiore Health System between March 11, 2020, and January 12, 2024. The final cohorts comprised 1380 hospitalised with COVID-19, 1702 non-hospitalised with COVID-19, 7264 contemporary COVID- controls, and 8492 historical controls (January 1, 2016-December 31, 2019). Primary outcomes were all-cause mortality, new-onset congestive heart failure (CHF), myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). Cox and Fine-Gray regression models with multivariate adjustment, propensity matching, and inverse probability weighting were applied. Outcomes were also analysed with respect to inflammatory and haematologic biomarkers obtained during acute infection.
FINDINGS: Compared to contemporary controls, patients hospitalised with COVID-19, but not patients not hospitalised with COVID-19, had higher future risk of MACE (adjusted HR = 1.58 [1.38, 1.80]), mortality, CHF, MI, and stroke up to four years post-infection (p < 0.05). Analysis using propensity-score matching and inverse probability weighting corroborated the results of multivariate regression. Sensitivity analyses using historical controls and a cohort without excluding early death or loss to follow-up showed consistent results. Among patients hospitalised for COVID-19, elevated neutrophil-to-lymphocyte ratio, ferritin, D-dimer, creatinine, low haemoglobin, and abnormal platelets were associated with increased risk for MACE.
INTERPRETATION: Severe COVID-19 is associated with long-term cardiovascular risk in patients with pre-existing CAD. Abnormal biomarkers during acute infection were associated with increased risk for MACE. These findings underscore the need for monitoring for cardiovascular risk in patients with pre-existing CAD.
FUNDING: None.
METHODS: Patients with pre-existing CAD were classified as COVID+ or COVID- based on the polymerase-chain-reaction test in the Montefiore Health System between March 11, 2020, and January 12, 2024. The final cohorts comprised 1380 hospitalised with COVID-19, 1702 non-hospitalised with COVID-19, 7264 contemporary COVID- controls, and 8492 historical controls (January 1, 2016-December 31, 2019). Primary outcomes were all-cause mortality, new-onset congestive heart failure (CHF), myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). Cox and Fine-Gray regression models with multivariate adjustment, propensity matching, and inverse probability weighting were applied. Outcomes were also analysed with respect to inflammatory and haematologic biomarkers obtained during acute infection.
FINDINGS: Compared to contemporary controls, patients hospitalised with COVID-19, but not patients not hospitalised with COVID-19, had higher future risk of MACE (adjusted HR = 1.58 [1.38, 1.80]), mortality, CHF, MI, and stroke up to four years post-infection (p < 0.05). Analysis using propensity-score matching and inverse probability weighting corroborated the results of multivariate regression. Sensitivity analyses using historical controls and a cohort without excluding early death or loss to follow-up showed consistent results. Among patients hospitalised for COVID-19, elevated neutrophil-to-lymphocyte ratio, ferritin, D-dimer, creatinine, low haemoglobin, and abnormal platelets were associated with increased risk for MACE.
INTERPRETATION: Severe COVID-19 is associated with long-term cardiovascular risk in patients with pre-existing CAD. Abnormal biomarkers during acute infection were associated with increased risk for MACE. These findings underscore the need for monitoring for cardiovascular risk in patients with pre-existing CAD.
FUNDING: None.