Lu Jason Y, Lu Justin Y, Wang Stephen H, Duong Katie S, Hou Wei, Duong Tim Q
Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Sci Rep. 2024 Dec 28;14(1):31451. doi: 10.1038/s41598-024-82983-7.
This study investigated the incidence of new-onset cardiovascular disorders up to 3.5 years post SARS-CoV-2 infection for 56,400 individuals with COVID-19 and 1,093,904 contemporary controls without COVID-19 in the Montefiore Health System (03/11/2020 to 07/01/2023). Outcomes were new incidence of major adverse cardiovascular event (MACE), arrhythmias, inflammatory heart disease, thrombosis, cerebrovascular disorders, ischemic heart disease and other cardiac disorders between 30 days and (up to) 3.5 years post index date. Results were also compared with a pre-pandemic cohort over similar observation duration (N = 64,541). Cumulative incidence and hazard ratios adjusted for competitive risks were analyzed. Compared to contemporary controls, hospitalized COVID-19 patients had significantly higher risk of developing MACE (aHR = 2.29, 95% confidence interval [2.27, 2.31], p < 0.001), arrhythmias (aHR = 2.54[2.50, 2.58], p < 0.001), inflammatory heart disease (aHR = 5.34[4.79, 5.96], p < 0.001), cerebrovascular (aHR = 2.05[2.00, 2.11], p < 0.001), other cardiac disorders (aHR = 2.31[2.26, 2.35], p < 0.001), thrombosis (aHR = 4.25[4.15, 4.36], p < 0.001), and ischemic heart disease (aHR = 1.89[1.86, 1.92], p < 0.001). Non-hospitalized COVID-19 patients had slightly higher risk of developing MACE (aHR = 1.04[1.03, 1.06], p < 0.001), arrhythmias (aHR = 1.10[1.08, 1.12], p < 0.001), inflammatory heart disease (aHR = 2.29 [2.03, 2.59], p < 0.001), cerebrovascular (aHR = 1.11[1.07, 1.15], p < 0.001), and ischemic heart disease (aHR = 1.10[1.08, 1.13], p < 0.001). Race and ethnicity were mostly not associated with increased risks (p > 0.05). aHRs with contemporary controls as a reference were similar to those with pre-pandemic cohort as a reference. We concluded that new incident cardiovascular disorders in COVID-19 patients, especially those hospitalized for COVID-19, were higher than those in controls. Identifying risk factors for developing new-onset cardiovascular disorders may draw clinical attention for the need for careful follow-up in at-risk individuals.
本研究调查了蒙特菲奥里医疗系统中56400例新冠病毒感染患者和1093904例同时期未感染新冠病毒的对照个体在感染SARS-CoV-2后长达3.5年的新发心血管疾病发病率（2020年3月11日至2023年7月1日）。观察指标为在索引日期后30天至（最长）3.5年内主要不良心血管事件（MACE）、心律失常、炎症性心脏病、血栓形成、脑血管疾病、缺血性心脏病及其他心脏疾病的新发病率。研究结果还与疫情前队列在相似观察期（N = 64541）的数据进行了比较。分析了竞争风险调整后的累积发病率和风险比。与同时期对照相比，新冠病毒感染住院患者发生MACE（调整后风险比[aHR]=2.29，95%置信区间[2.27, 2.31]，p<0.001）、心律失常（aHR = 2.54[2.50, 2.58]，p<0.001）、炎症性心脏病（aHR = 5.34[4.79, 5.96]，p<0.001）、脑血管疾病（aHR = 2.05[2.00, 2.11]，p<0.001）、其他心脏疾病（aHR = 2.31[2.26, 2.35]，p<0.001）、血栓形成（aHR = 4.25[4.15, 4.36]，p<0.001）和缺血性心脏病（aHR = 1.89[1.86, 1.92]，p<0.001）的风险显著更高。新冠病毒感染非住院患者发生MACE（aHR = 1.04[1.03, 1.06]，p<0.001）、心律失常（aHR = 1.10[1.08, 1.12]，p<0.001）、炎症性心脏病（aHR = 2.29 [2.03, 2.59]）、脑血管疾病（aHR = 1.11[1.07, 1.15]，p<0.001）和缺血性心脏病（aHR = 1.10[1.08, 1.13]，p<0.001）的风险略高。种族和民族大多与风险增加无关（p>0.05）。以同时期对照为参照的aHR与以疫情前队列作为参照的aHR相似。我们得出结论，新冠病毒感染患者尤其是因新冠病毒感染住院患者的新发心血管疾病高于对照组。识别新发心血管疾病的风险因素可能会引起临床对高危个体进行密切随访必要性的关注。
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