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Multicenter Study
. 2022 Dec 30;17(12):e0279333.
doi: 10.1371/journal.pone.0279333. eCollection 2022.

One-year cardiovascular outcomes after coronavirus disease 2019: The cardiovascular COVID-19 registry

Luis Ortega-Paz  1   2 , Victor Arévalos  1 , Diego Fernández-Rodríguez  3 , Víctor Jiménez-Díaz  4 , Jordi Bañeras  5 , Gianluca Campo  6 , Miguel Rodríguez-Santamarta  7 , José Francisco Díaz  8 , Claudia Scardino  9 , Zaira Gómez-Álvarez  10 , Alberto Pernigotti  11 , Fernando Alfonso  12 , Ignacio J Amat-Santos  13 , Antonio Silvestro  14 , Lorenzo Rampa  15 , José M de la Torre Hernández  16 , Gabriela Bastidas  17 , Josep Gómez-Lara  18 , Behnood Bikdeli  19   20   21 , Hector M García-García  22 , Dominick J Angiolillo  2 , Josep Rodés-Cabau  1 , Manel Sabaté  1 , Salvatore Brugaletta  1 ; CV COVID-19 registry investigators
Affiliations
Multicenter Study

One-year cardiovascular outcomes after coronavirus disease 2019: The cardiovascular COVID-19 registry

Luis Ortega-Paz et al. PLoS One. .

Abstract

Background: The long-term cardiovascular (CV) outcomes of COVID-19 have not been fully explored.

Methods: This was an international, multicenter, retrospective cohort study conducted between February and December 2020. Consecutive patients ≥18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 were included. Patients were classified into two cohorts depending on the nasopharyngeal swab result and clinical status: confirmed COVID-19 (positive RT-PCR) and control (without suggestive symptoms and negative RT-PCR). Data were obtained from electronic records, and clinical follow-up was performed at 1-year. The primary outcome was CV death at 1-year. Secondary outcomes included arterial thrombotic events (ATE), venous thromboembolism (VTE), and serious cardiac arrhythmias. An independent clinical event committee adjudicated events. A Cox proportional hazards model adjusted for all baseline characteristics was used for comparing outcomes between groups. A prespecified landmark analysis was performed to assess events during the post-acute phase (31-365 days).

Results: A total of 4,427 patients were included: 3,578 (80.8%) in the COVID-19 and 849 (19.2%) control cohorts. At one year, there were no significant differences in the primary endpoint of CV death between the COVID-19 and control cohorts (1.4% vs. 0.8%; HRadj 1.28 [0.56-2.91]; p = 0.555), but there was a higher risk of all-cause death (17.8% vs. 4.0%; HRadj 2.82 [1.99-4.0]; p = 0.001). COVID-19 cohort had higher rates of ATE (2.5% vs. 0.8%, HRadj 2.26 [1.02-4.99]; p = 0.044), VTE (3.7% vs. 0.4%, HRadj 9.33 [2.93-29.70]; p = 0.001), and serious cardiac arrhythmias (2.5% vs. 0.6%, HRadj 3.37 [1.35-8.46]; p = 0.010). During the post-acute phase, there were no significant differences in CV death (0.6% vs. 0.7%; HRadj 0.67 [0.25-1.80]; p = 0.425), but there was a higher risk of deep vein thrombosis (0.6% vs. 0.0%; p = 0.028). Re-hospitalization rate was lower in the COVID-19 cohort compared to the control cohort (13.9% vs. 20.6%; p = 0.001).

Conclusions: At 1-year, patients with COVID-19 experienced an increased risk of all-cause death and adverse CV events, including ATE, VTE, and serious cardiac arrhythmias, but not CV death.

Study registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04359927.

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Conflict of interest statement

GC received research grants from Boston Scientific, Medis, SMT, Siemens, Insight Lifetech. BB reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters. HGG reports a relationship with Biotronik, Boston Scientific, Medtronic, Abbott, Neovasc, Shockwave, Philips, and CorFlow that includes: funding grants. DJA declares that he has received consulting fees or honoraria from Abbott, Amgen, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer, and Sanofi. DJA also declares that his institution has received research grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Idorsia, Janssen, Matsutani Chemical Industry Co., Merck, Novartis, Osprey Medical, Renal Guard Solutions, and the Scott R. MacKenzie Foundation. JRC is consultant for and has received institutional research grants from Edwards Lifesciences, Medtronic and Boston Scientific. MS declares that he is a consultant for Abbott Vascular and iVascular. SB declares that he is a consultant from Boston Scientific, iVascular and Teleflex, and he received speaker’s fee from Abbott Vascular, outside the present work. Other authors have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Cumulative incidence of cardiovascular death in the COVID-19 and control cohorts.
Cumulative 1-year incidences are shown with Kaplan-Meier event rates with 95% CI. (A1) Entire study comprised from 0–365 days and (A2) post-acute phase from 31–365 days. Adj HR, adjusted hazard ratio; 95%CI, 95% confidence interval.
Fig 2
Fig 2. Cumulative incidence of adverse cardiovascular events and serious cardiac arrythmias in the COVID-19 and control cohorts.
Cumulative 1-year incidences are shown with Kaplan-Meier event rates with 95% CI. (A1 and B1) Entire study comprised from 0–365 days and (A2 and B2) post-acute phase from 31–365 days. Adj HR, adjusted hazard ratio; 95%CI, 95% confidence interval.
Fig 3
Fig 3. Cumulative incidence of arterial thrombotic events and venous thromboembolism in the COVID-19 and control cohorts.
Cumulative 1-year incidences are shown with Kaplan-Meier event rates with 95% CI. (A1 and B1) Entire study comprised from 0–365 days and (A2 and B2) post-acute phase from 31–365 days. Adj HR, adjusted hazard ratio; 95%CI, 95% confidence interval.
Fig 4
Fig 4. Multivariable predictors of adverse cardiovascular events during the post-acute phase in patients with COVID-19.
Adverse cardiovascular events are defined as the composite of cardiovascular death, any venous or arterial thrombotic event, heart failure hospitalization, or any serious arrhythmia. Post-acute phase comprised from 31–365 days of follow-up. ¥Cox proportional hazards regression analysis adjusted by the significant variables in univariate analysis using a backward selection model. 95%CI, 95% confidence interval; VHD, valvular heart disease; drugs; ICU: intensive care unit; FHS, functional health status.
See this image and copyright information in PMC

References

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