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. 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.

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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.

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