新冠肺炎后一年的心血管结局：心血管 COVID-19 注册研究。
One-year cardiovascular outcomes after coronavirus disease 2019: The cardiovascular COVID-19 registry.
机构信息
Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain.
Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States of America.
出版信息
PLoS One. 2022 Dec 30;17(12):e0279333. doi: 10.1371/journal.pone.0279333. eCollection 2022.
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.
背景
COVID-19 的长期心血管（CV）结局尚未得到充分探讨。
方法
这是一项国际多中心回顾性队列研究，于 2020 年 2 月至 12 月进行。纳入接受实时逆转录-聚合酶链反应（RT-PCR）检测 SARS-CoV2 的年龄≥18 岁的连续患者。根据鼻咽拭子结果和临床情况将患者分为两个队列：确诊 COVID-19（阳性 RT-PCR）和对照组（无提示症状和阴性 RT-PCR）。数据来自电子病历，临床随访至 1 年。主要结局是 1 年时的 CV 死亡。次要结局包括动脉血栓栓塞事件（ATE）、静脉血栓栓塞（VTE）和严重心律失常。独立临床事件委员会对事件进行裁决。使用调整所有基线特征的 Cox 比例风险模型比较组间结局。进行了预先指定的里程碑分析，以评估急性后阶段（31-365 天）的事件。
结果
共纳入 4427 例患者：COVID-19 队列 3578 例（80.8%），对照组 849 例（19.2%）。1 年时，COVID-19 队列和对照组在主要终点 CV 死亡方面无显著差异（1.4% vs. 0.8%；HRadj 1.28 [0.56-2.91]；p = 0.555），但全因死亡率较高（17.8% vs. 4.0%；HRadj 2.82 [1.99-4.0]；p = 0.001）。COVID-19 队列的 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）和严重心律失常（2.5% vs. 0.6%，HRadj 3.37 [1.35-8.46]；p = 0.010）发生率较高。急性后阶段，CV 死亡无显著差异（0.6% vs. 0.7%；HRadj 0.67 [0.25-1.80]；p = 0.425），但深静脉血栓形成风险较高（0.6% vs. 0.0%；p = 0.028）。COVID-19 队列的再住院率低于对照组（13.9% vs. 20.6%；p = 0.001）。
结论
1 年时，COVID-19 患者全因死亡和不良 CV 事件风险增加，包括 ATE、VTE 和严重心律失常，但 CV 死亡无增加。
研究注册
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