Mink Sylvia, Drexel Heinz, Leiherer Andreas, Cadamuro Janne, Hitzl Wolfgang, Frick Matthias, Reimann Patrick, Saely Christoph H, Fraunberger Peter
Central Medical Laboratories, 6800 Feldkirch, Austria.
Private University in the Principality of Liechtenstein, 9495 Triesen, Liechtenstein.
Vaccines (Basel). 2024 Jul 30;12(8):855. doi: 10.3390/vaccines12080855.
Despite the currently prevailing, milder Omicron variant, coronary artery disease (CAD) patients constitute a major risk group in COVID-19, exhibiting 2.6 times the mortality risk of non-CAD patients and representing over 22% of non-survivors. No data are currently available on the efficacy of antibody levels in CAD patients, nor on the relevance of vaccination status versus antibody levels for predicting severe courses and COVID-19 mortality. Nor are there definitive indicators to assess if individual CAD patients are sufficiently protected from adverse outcomes or to determine the necessity of booster vaccinations.
A prospective, propensity-score-matched, multicenter cohort study comprising 249 CAD patients and 903 controls was conducted. Anti-SARS-CoV-2-spike antibodies were measured on hospital admission. Prespecified endpoints were in-hospital mortality, intensive care, and oxygen administration.
After adjustment for potential confounders, CAD patients exhibited 4.6 and 6.1-times higher mortality risks if antibody levels were <1200 BAU/mL and <182 BAU/mL, respectively, compared to CAD patients above these thresholds (aOR 4.598, 95%CI 2.426-8.714, < 0.001; 6.147, 95%CI 2.529-14.941, < 0.001). Risk of intensive care was 3.7 and 4.0 ( = 0.003; < 0.001), and risk of oxygen administration 2.6 and 2.4 times higher below these thresholds ( = 0.004; = 0.010). Vaccination status was a weaker predictor of all three outcomes than both antibody thresholds.
Antibody levels are a stronger predictor of outcome in CAD patients with COVID-19 than vaccination status, with 1200 BAU/mL being the more conservative threshold. Measuring anti-SARS-CoV-2 antibodies in CAD patients may ensure enhanced protection by providing timely booster vaccinations and identifying high-risk CAD patients at hospital admission.
尽管目前流行的奥密克戎变异株致病性较弱，但冠心病（CAD）患者仍是新冠病毒感染（COVID-19）的主要风险群体，其死亡风险是非CAD患者的2.6倍，且占非幸存者的22%以上。目前尚无关于CAD患者抗体水平疗效的数据，也没有关于疫苗接种状况与抗体水平对预测重症病程和COVID-19死亡率的相关性的数据。此外，也没有明确的指标来评估个体CAD患者是否得到充分保护以避免不良后果，或确定加强接种疫苗的必要性。
进行了一项前瞻性、倾向评分匹配的多中心队列研究，纳入249例CAD患者和903例对照。入院时检测抗SARS-CoV-2刺突抗体。预先设定的终点为住院死亡率、重症监护和吸氧情况。
在调整潜在混杂因素后，与抗体水平高于这些阈值的CAD患者相比，抗体水平<1200 BAU/mL和<182 BAU/mL的CAD患者的死亡风险分别高出4.6倍和6.1倍（调整后比值比4.598，95%置信区间2.426-8.714，P<0.001；6.147，95%置信区间2.529-14.941，P<0.001）。低于这些阈值时，重症监护风险分别为3.7倍和4.0倍（P = 0.003；P<0.001），吸氧风险分别高出2.6倍和2.4倍（P = 0.004；P = 0.010）。疫苗接种状况对所有三个结局的预测作用均弱于两个抗体阈值。
对于COVID-19的CAD患者，抗体水平比疫苗接种状况更能预测结局，1200 BAU/mL是更保守的阈值。检测CAD患者的抗SARS-CoV-2抗体，可通过及时加强接种疫苗和在入院时识别高危CAD患者来确保增强保护。
