Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun;39(3):573-581.
doi: 10.1007/s10557-024-07570-4. Epub 2024 Mar 11.

The Impacts of Nirmatrelvir-Ritonavir on Myocardial Injury and Long-Term Cardiovascular Outcomes in Hospitalized Patients with COVID-19 amid the Omicron Wave of the Pandemic

Jun Gu  1 , Zhi-Hua Han  2 , Chang-Qian Wang  2 , Jun-Feng Zhang  3
Affiliations

The Impacts of Nirmatrelvir-Ritonavir on Myocardial Injury and Long-Term Cardiovascular Outcomes in Hospitalized Patients with COVID-19 amid the Omicron Wave of the Pandemic

Jun Gu et al. Cardiovasc Drugs Ther. 2025 Jun.

Abstract

Purpose: Even though nirmatrelvir-ritonavir can improve the short-term morbidity and mortality in COVID-19 patients, the effects of this treatment on long-term major adverse cardiovascular events (MACEs), especially myocardial injury, remains undetermined.

Methods: This prospective cohort study identified hospitalized adult patients with COVID-19 between April 19, 2022, and June 9, 2022, amid the omicron wave of the pandemic. Matched nirmatrelvir-ritonavir-treated and non-treated cohorts were formed using the propensity score matching method. The primary outcome of this study was the incidence of MACEs (cardiovascular death, myocardial infarction, stroke, new-onset heart failure or heart failure hospitalization or ventricular arrhythmia) from 30 days to 16 months after the diagnosis of COVID-19.

Results: Two 949-patient cohorts with balanced baseline characteristics were formed by propensity score matching. Patients with nirmatrelvir-ritonavir, compared to those untreated, had a lower level of troponin I peak as well as the incidence of troponin I elevation. During the follow-up period, 59 patients in the nirmatrelvir-ritonavir group and 86 patients in the control group developed MACEs (P = 0.020). Regarding specific constituents of MACEs, the differences are mainly reflected in new-onset heart failure or heart failure hospitalization. COVID-19 clinical severity and troponin I peak were the independent predictors, while nirmatrelvir-ritonavir was the independent protective factor for the occurrence of MACEs in this population.

Conclusion: Nirmatrelvir-ritonavir was effective in reducing myocardial injury as well as long-term adverse cardiovascular outcomes among hospitalized patients with COVID-19 amid the omicron wave of the pandemic.

Keywords: COVID-19; Major adverse cardiovascular events; Myocardial injury; Nirmatrelvir–ritonavir.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics Approval: All aspects of conducting the study, including the consent process and collection of the assessments used in this analysis, were approved by institutional ethics review boards. Consent to Participate: Informed consent was obtained from all individual participants included in the study. Consent for Publication: All authors approved the final manuscript and the submission to this journal. Competing Interests: The authors declare no competing interests.

Similar articles

See all similar articles

Cited by

References

    1. Giardina F, Ferrari G, Zavaglio F, et al. An overview of SARS-CoV-2 variants circulating in the 2020–2022 period in Lombardy. Diagn Microbiol Infect Dis. 2023;107(4):116070. https://doi.org/10.1016/j.diagmicrobio.2023.116070 - DOI - PubMed
    1. Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17(9):543–58. https://doi.org/10.1038/s41569-020-0413-9 - DOI - PubMed - PMC
    1. Chung MK, Zidar DA, Bristow MR, et al. COVID-19 and cardiovascular disease: from bench to bedside. Circ Res. 2021;128(8):1214–36. https://doi.org/10.1161/CIRCRESAHA.121.317997 - DOI - PubMed - PMC
    1. RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021;397(10285):1637-1645. https://doi.org/10.1016/S0140-6736(21)00676-0
    1. Santoso A, Pranata R, Wibowo A, Al-Farabi MJ, Huang I, Antariksa B. Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: a meta-analysis. Am J Emerg Med. 2021;44:352–7. https://doi.org/10.1016/j.ajem.2020.04.052 - DOI - PubMed

LinkOut - more resources