One-year cardiovascular outcomes after coronavirus disease 2019: The cardiovascular COVID-19 registry

Abstract

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.

Elevated FAI Index of Pericoronary Inflammation on Coronary CT Identifies Increased Risk of Coronary Plaque Vulnerability after COVID-19 Infection

“…Several studies have reported that COVID-19 infected patients have a higher incidence of cardiovascular events, including acute myocardial infarction, stroke, and heart failure, within one year of infection [ 31 ]. Additionally, Katsoularis et al conducted a self-controlled case series and matched cohort study in Sweden, which showed an increased risk of acute myocardial infarction and ischemic stroke following COVID-19 [ 32 ].…”

Pneumonia-Induced Inflammation, Resolution and Cardiovascular Disease: Causes, Consequences and Clinical Opportunities

“…195,197,198 A large retrospective study of 153 760 COVID-19 survivors found that when compared with controls without the infection, the risk of cardiovascular events (including ischemic heart disease, heart failure, inflammatory heart disease, arrhythmias, cerebrovascular events, thromboembolic events, and other cardiac disorders) remains increased by 63% at 1 year even after adjustment for traditional cardiovascular risk factors and pre-COVID-19 health care utilization. 195 Subsequent studies have confirmed the elevated risk of cardiovascular events [197][198][199] and subsequent risk of mortality. 200,201 The proposed mechanisms linking COVID-19 infection with an increased risk of cardiovascular events are similar to those described from other bacterial and viral infections.…”

Epidemiology and Predisposing Factors of Post-COVID Venous Thrombosis: A Concise Review

“…In the same year, Ortega-Paz et al published the results of an international, multicenter cohort study with 4,427 participants (3,578 in the COVID-19 and 849 in the control cohort, respectively) who were followed up for incident venous thrombosis between 31 and 365 days after the acute phase (in the COVID-19 cohort). 12 After 1 year of follow-up, patients who recovered from COVID-19 had an almost 10fold higher risk of developing venous thrombotic episodes (adjusted HR, 9.33; 95%CI, 2.93-29.70). Older age, male sex, length of hospital or ICU stay, and mechanical ventilation were found to be significant predictors of adverse cardiovascular events.…”