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One-year cardiovascular outcomes after coronavirus disease 2019: The cardiovascular COVID-19 registry
Luis Ortega-Paz1,2, Victor Arévalos1, Diego Fernández-Rodríguez3
1Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain.
Insights
COVID-19 survivors faced higher risks of death from any cause, arterial thrombotic events, venous thromboembolism, and cardiac arrhythmias one year after infection. However, cardiovascular death rates did not significantly differ between COVID-19 and control groups.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Long-term cardiovascular (CV) outcomes following COVID-19 infection remain incompletely understood.
- The study addresses the need for comprehensive data on the post-acute CV sequelae of SARS-CoV-2 infection.
Purpose of the Study:
- To investigate the 1-year cardiovascular outcomes in patients with confirmed COVID-19 compared to a control group.
- To assess the incidence of major adverse CV events, including CV death, arterial thrombotic events (ATE), venous thromboembolism (VTE), and serious cardiac arrhythmias.
Main Methods:
- International, multicenter, retrospective cohort study including 4,427 patients (3,578 COVID-19, 849 controls) with 1-year follow-up.
- Outcomes assessed included CV death, ATE, VTE, and cardiac arrhythmias, with adjudication by an independent committee.
- Cox proportional hazards models and landmark analysis were used to compare outcomes between cohorts.
Main Results:
- No significant difference in 1-year CV death rates (1.4% vs. 0.8%).
- Increased risk of all-cause death (17.8% vs. 4.0%), ATE (2.5% vs. 0.8%), VTE (3.7% vs. 0.4%), and serious cardiac arrhythmias (2.5% vs. 0.6%) in the COVID-19 cohort.
- Higher risk of deep vein thrombosis observed during the post-acute phase (31-365 days).
Conclusions:
- COVID-19 survivors exhibit elevated risks for all-cause mortality and specific adverse cardiovascular events one year post-infection.
- While not increasing CV death, COVID-19 is associated with significant long-term risks of thrombotic events and arrhythmias.
Background:
The long-term cardiovascular (CV) outcomes of COVID-19 have not been fully explored.
Methods:
This was an international, multicenter, retrospective cohort study conducted between February and December 2020. Consecutive patients ≥18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 were included. Patients were classified into two cohorts depending on the nasopharyngeal swab result and clinical status: confirmed COVID-19 (positive RT-PCR) and control (without suggestive symptoms and negative RT-PCR). Data were obtained from electronic records, and clinical follow-up was performed at 1-year. The primary outcome was CV death at 1-year. Secondary outcomes included arterial thrombotic events (ATE), venous thromboembolism (VTE), and serious cardiac arrhythmias. An independent clinical event committee adjudicated events. A Cox proportional hazards model adjusted for all baseline characteristics was used for comparing outcomes between groups. A prespecified landmark analysis was performed to assess events during the post-acute phase (31-365 days).
Results:
A total of 4,427 patients were included: 3,578 (80.8%) in the COVID-19 and 849 (19.2%) control cohorts. At one year, there were no significant differences in the primary endpoint of CV death between the COVID-19 and control cohorts (1.4% vs. 0.8%; HRadj 1.28 [0.56-2.91]; p = 0.555), but there was a higher risk of all-cause death (17.8% vs. 4.0%; HRadj 2.82 [1.99-4.0]; p = 0.001). COVID-19 cohort had higher rates of ATE (2.5% vs. 0.8%, HRadj 2.26 [1.02-4.99]; p = 0.044), VTE (3.7% vs. 0.4%, HRadj 9.33 [2.93-29.70]; p = 0.001), and serious cardiac arrhythmias (2.5% vs. 0.6%, HRadj 3.37 [1.35-8.46]; p = 0.010). During the post-acute phase, there were no significant differences in CV death (0.6% vs. 0.7%; HRadj 0.67 [0.25-1.80]; p = 0.425), but there was a higher risk of deep vein thrombosis (0.6% vs. 0.0%; p = 0.028). Re-hospitalization rate was lower in the COVID-19 cohort compared to the control cohort (13.9% vs. 20.6%; p = 0.001).
Conclusions:
At 1-year, patients with COVID-19 experienced an increased risk of all-cause death and adverse CV events, including ATE, VTE, and serious cardiac arrhythmias, but not CV death.
Study Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT04359927.
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