Patel Rushin, Dani Sourbha S, Khadke Sumanth, Kumar Ashish, Ahmad Javaria, Saji Anu Mariam, Shah Jui, Mehta Neev, Wener Kenneth, McQuillen Daniel P, Abraham George, Faust Jeremy, Maley Jason, Patel Smita, Mullington Janet, Wachter Robert M, Mosenthal Anne, Sax Paul E, Ganatra Sarju
Department of Internal Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.
Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.
JACC Adv. 2024 Jun 26;3(6):100961. doi: 10.1016/j.jacadv.2024.100961. eCollection 2024 Jun.
There is limited evidence of association of nirmatrelvir-ritonavir (NMV-r) and incidence of postacute sequelae of SARS-CoV-2 infection (PASC) in patients with pre-existing cardiovascular disease (CVD).
The objective of this study was to assess the association of NMV-r in nonhospitalized, vaccinated patients with pre-existing CVD and occurrence of PASC.
We conducted a retrospective cohort study utilizing the TriNetX research network, including vaccinated patients with pre-existing CVD who developed COVID-19 between December 2021 and December 2022. Two cohorts were created based on NMV-r administration within 5 days of diagnosis: NMV-r and non-NMV-r cohort. The main outcome was presence of PASC, assessed between 30 to 90 days and 90 to 180 days after index COVID-19 infection. After propensity score matching, both cohorts were compared using t-test and chi-square test for continuous and categorical variables, respectively.
A total of 26,953 patients remained in each cohort after propensity score matching. Broadly defined PASC occurred in 6,925 patients (26%) in the NMV-r cohort vs 8,150 patients (30.6%) in the non-NMV-r cohort (OR: 0.80; 95% CI: 0.76-0.82; < 0.001) from 30 to 90 days and in 6,692 patients (25.1%) as compared to 8,910 patients (33.5%) (OR: 0.25, 95% CI: 0.23-0.29; < 0.001) from 90 to 180 days. Similarly, narrowly defined PASC occurred in 5,335 patients (20%) in the NMV-r cohort vs 6,271 patients (23.6%) in the non-NMV-r cohort between 30 and 90 days (OR: 0.81, 95% CI: 0.78-0.84, < 0.001) and in 5,121 patients (19.2%) as compared to 6,964 patients (26.1%) (OR: 0.67, 95% CI: 0.64-0.70, < 0.001) between 90 and 180 days.
NMV-r in nonhospitalized vaccinated patients with pre-existing CVD with COVID-19 was associated with a reduction in PASC and health care utilization.
在患有心血管疾病（CVD）的患者中，关于奈玛特韦-利托那韦（NMV-r）与新型冠状病毒感染后急性后遗症（PASC）发生率之间关联的证据有限。
本研究的目的是评估NMV-r在患有CVD的非住院、接种疫苗患者中与PASC发生情况之间的关联。
我们利用TriNetX研究网络进行了一项回顾性队列研究，纳入2021年12月至2022年12月期间确诊感染新型冠状病毒且患有CVD的接种疫苗患者。根据诊断后5天内是否使用NMV-r创建了两个队列：NMV-r队列和非NMV-r队列。主要结局是PASC的存在情况，在首次感染新型冠状病毒后的30至90天以及90至180天进行评估。在倾向得分匹配后，分别使用t检验和卡方检验对两个队列的连续变量和分类变量进行比较。
倾向得分匹配后，每个队列各有26,953名患者。广义定义的PASC在NMV-r队列的6,925名患者（26%）中出现，而非NMV-r队列中有8,150名患者（30.6%）出现（比值比：0.80；95%置信区间：0.76 - 0.82；P < 0.001），在30至90天期间；在90至180天期间，NMV-r队列中有6,692名患者（25.1%）出现，而非NMV-r队列中有8,910名患者（33.5%）出现（比值比：0.25，95%置信区间：0.23 - 0.29；P < 0.001）。同样，狭义定义的PASC在30至90天期间，NMV-r队列的5,335名患者（20%）中出现，而非NMV-r队列中有6,271名患者（23.6%）出现（比值比：0.81，95%置信区间：0.78 - 0.84，P < 0.001）；在90至180天期间，NMV-r队列中有5,121名患者（19.2%）出现，而非NMV-r队列中有6,964名患者（26.1%）出现（比值比：0.67，95%置信区间：0.64 - 0.70，P < 0.001）。
在患有CVD且感染新型冠状病毒的非住院接种疫苗患者中，使用NMV-r与PASC减少及医疗保健利用率降低相关。
