Lim Jue Tao, Liang En Wee, Tay An Ting, Pang Deanette, Chiew Calvin J, Ong Benjamin, Lye David Chien Boon, Tan Kelvin Bryan
Lee Kong Chian School of Medicine, Nanyang Technological University.
National Centre for Infectious Diseases.
Clin Infect Dis. 2024 Jan 25;78(1):70-79. doi: 10.1093/cid/ciad469.
Growing evidence suggests that some coronavirus disease 2019 (COVID-19) survivors experience a wide range of long-term postacute sequelae. We examined the postacute risk and burden of new-incident cardiovascular, cerebrovascular, and other thrombotic complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a highly vaccinated multiethnic Southeast Asian population, during Delta predominance.
This cohort study used national testing and healthcare claims databases in Singapore to build a cohort of individuals who had a positive SARS-CoV-2 test between 1 September and 30 November 2021 when Delta predominated community transmission. Concurrently, we constructed a test-negative control group by enrolling individuals between 13 April 2020 and 31 December 2022 with no evidence of SARS-CoV-2 infection. Participants in both groups were followed up for a median of 300 days. We estimated risks of new-incident cardiovascular, cerebrovascular, and other thrombotic complications using doubly robust competing-risks survival analysis. Risks were reported using 2 measures: hazard ratio (HR) and excess burden (EB) with 95% confidence intervals.
We included 106 012 infected cases and 1 684 085 test-negative controls. Compared with the control group, individuals with COVID-19 exhibited increased risk (HR, 1.157 [1.069-1.252]) and excess burden (EB, 0.70 [.53-.88]) of new-incident cardiovascular and cerebrovascular complications. Risks decreased in a graded fashion for fully vaccinated (HR, 1.11 [1.02-1.22]) and boosted (HR, 1.10 [.92-1.32]) individuals. Conversely, risks and burdens of subsequent cardiovascular/cerebrovascular complications increased for hospitalized and severe COVID-19 cases (compared to nonhospitalized cases).
Increased risks and excess burdens of new-incident cardiovascular/cerebrovascular complications were reported among infected individuals; risks can be attenuated with vaccination and boosting.
越来越多的证据表明，一些2019冠状病毒病（COVID-19）幸存者会经历一系列广泛的长期急性后遗症。我们在Delta毒株占主导的时期，对一个接种疫苗比例高的多民族东南亚人群进行了研究，以调查严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染后新发生的心血管、脑血管和其他血栓形成并发症的急性后风险和负担。
这项队列研究利用新加坡的国家检测和医疗保健索赔数据库，建立了一个在2021年9月1日至11月30日Delta毒株主导社区传播期间SARS-CoV-2检测呈阳性的个体队列。同时，我们通过纳入2020年4月13日至2022年12月31日期间没有SARS-CoV-2感染证据的个体，构建了一个检测阴性对照组。两组参与者的中位随访时间为300天。我们使用双重稳健竞争风险生存分析来估计新发生的心血管、脑血管和其他血栓形成并发症的风险。风险用两种指标报告：风险比（HR）和超额负担（EB），并给出95%置信区间。
我们纳入了106012例感染病例和1684085例检测阴性对照。与对照组相比，COVID-19患者新发生心血管和脑血管并发症的风险（HR，1.157[1.069-1.252]）和超额负担（EB，0.70[0.53-0.88]）增加。对于完全接种疫苗（HR，1.11[1.02-1.22]）和接种加强针（HR，1.10[0.92-1.32]）的个体，风险呈分级下降。相反，住院和重症COVID-19病例（与非住院病例相比）随后发生心血管/脑血管并发症的风险和负担增加。
在感染个体中报告了新发生心血管/脑血管并发症的风险和超额负担增加；接种疫苗和加强针可降低风险。
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