Long-term outcomes of patients with pre-existing coronary artery disease after SARS-CoV-2 infection.

BACKGROUND

The long-term outcomes of patients with pre-existing coronary artery disease (CAD) after SARS-CoV-2 infection are unknown.

METHODS

Patients with pre-existing CAD were classified as COVID+ or COVID- based on the polymerase-chain-reaction test in the Montefiore Health System between March 11, 2020, and January 12, 2024. The final cohorts comprised 1380 hospitalised with COVID-19, 1702 non-hospitalised with COVID-19, 7264 contemporary COVID- controls, and 8492 historical controls (January 1, 2016-December 31, 2019). Primary outcomes were all-cause mortality, new-onset congestive heart failure (CHF), myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). Cox and Fine-Gray regression models with multivariate adjustment, propensity matching, and inverse probability weighting were applied. Outcomes were also analysed with respect to inflammatory and haematologic biomarkers obtained during acute infection.

FINDINGS

Compared to contemporary controls, patients hospitalised with COVID-19, but not patients not hospitalised with COVID-19, had higher future risk of MACE (adjusted HR = 1.58 [1.38, 1.80]), mortality, CHF, MI, and stroke up to four years post-infection (p < 0.05). Analysis using propensity-score matching and inverse probability weighting corroborated the results of multivariate regression. Sensitivity analyses using historical controls and a cohort without excluding early death or loss to follow-up showed consistent results. Among patients hospitalised for COVID-19, elevated neutrophil-to-lymphocyte ratio, ferritin, D-dimer, creatinine, low haemoglobin, and abnormal platelets were associated with increased risk for MACE.

INTERPRETATION

Severe COVID-19 is associated with long-term cardiovascular risk in patients with pre-existing CAD. Abnormal biomarkers during acute infection were associated with increased risk for MACE. These findings underscore the need for monitoring for cardiovascular risk in patients with pre-existing CAD.

FUNDING

None.