Patel Brijesh, Chapman Scott A, Neumann Jake T, Visaria Aayush, Ogungbe Oluwabunmi, Wen Sijin, Khodaverdi Maryam, Makwana Priyal, Singh Jasvinder A, Sokos George
Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA.
WVU School of Medicine, Non-Invasive Cardiologist and Cardio-Oncology, WVU Heart & Vascular Institute, 1 Medical Center Drive, Box 8500, Morgantown, WV, 26505, USA.
Cardiooncology. 2023 Oct 6;9(1):36. doi: 10.1186/s40959-023-00187-w.
To determine the impact of acute SARS-CoV-2 infection on patient with concomitant active cancer and CVD.
The researchers extracted and analyzed data from the National COVID Cohort Collaborative (N3C) database between January 1, 2020, and July 22, 2022. They included only patients with acute SARS-CoV-2 infection, defined as a positive test by PCR 21 days before and 5 days after the day of index hospitalization. Active cancers were defined as last cancer drug administered within 30 days of index admission. The "Cardioonc" group consisted of patients with CVD and active cancers. The cohort was divided into four groups: (1) CVD (-), (2) CVD ( +), (3) Cardioonc (-), and (4) Cardioonc ( +), where (-) or ( +) denotes acute SARS-CoV-2 infection status. The primary outcome of the study was major adverse cardiovascular events (MACE), including acute stroke, acute heart failure, myocardial infarction, or all-cause mortality. The researchers analyzed the outcomes by different phases of the pandemic and performed competing-risk analysis for other MACE components and death as a competing event.
The study analyzed 418,306 patients, of which 74%, 10%, 15.7%, and 0.3% had CVD (-), CVD ( +), Cardioonc (-), and Cardioonc ( +), respectively. The Cardioonc ( +) group had the highest MACE events in all four phases of the pandemic. Compared to CVD (-), the Cardioonc ( +) group had an odds ratio of 1.66 for MACE. However, during the Omicron era, there was a statistically significant increased risk for MACE in the Cardioonc ( +) group compared to CVD (-). Competing risk analysis showed that all-cause mortality was significantly higher in the Cardioonc ( +) group and limited other MACE events from occurring. When the researchers identified specific cancer types, patients with colon cancer had higher MACE.
In conclusion, the study found that patients with both CVD and active cancer suffered relatively worse outcomes when they had acute SARS-CoV-2 infection during early and alpha surges in the United States. These findings highlight the need for improved management strategies and further research to better understand the impact of the virus on vulnerable populations during the COVID-19 pandemic.
确定急性SARS-CoV-2感染对合并活动性癌症和心血管疾病（CVD）患者的影响。
研究人员提取并分析了2020年1月1日至2022年7月22日期间美国国家新冠队列协作组（N3C）数据库中的数据。他们仅纳入了急性SARS-CoV-2感染患者，定义为在索引住院日期前21天至后5天内PCR检测呈阳性。活动性癌症定义为在索引入院前30天内使用过最后一种抗癌药物。“心脏肿瘤”组由患有CVD和活动性癌症的患者组成。该队列分为四组：（1）CVD（-），（2）CVD（+），（3）心脏肿瘤（-），和（4）心脏肿瘤（+），其中（-）或（+）表示急性SARS-CoV-2感染状态。该研究的主要结局是主要不良心血管事件（MACE），包括急性中风、急性心力衰竭、心肌梗死或全因死亡率。研究人员按疫情的不同阶段分析了结局，并对其他MACE组分和作为竞争事件的死亡进行了竞争风险分析。
该研究分析了418,306名患者，其中分别有74%、10%、15.7%和0.3%的患者患有CVD（-）、CVD（+）、心脏肿瘤（-）和心脏肿瘤（+）。在疫情的所有四个阶段中，心脏肿瘤（+）组的MACE事件发生率最高。与CVD（-）组相比，心脏肿瘤（+）组发生MACE的比值比为1.66。然而，在奥密克戎时代，与CVD（-）组相比，心脏肿瘤（+）组发生MACE的风险有统计学显著增加。竞争风险分析表明，心脏肿瘤（+）组的全因死亡率显著更高，且限制了其他MACE事件的发生。当研究人员确定特定癌症类型时，结肠癌患者的MACE发生率更高。
总之，该研究发现，在美国早期和阿尔法波峰期间，患有CVD和活动性癌症的患者在发生急性SARS-CoV-2感染时预后相对更差。这些发现凸显了改进管理策略和进一步开展研究以更好地了解该病毒在新冠疫情期间对脆弱人群影响的必要性。
