{"title":"SARS-CoV-2感染后既往冠状动脉疾病患者的长期预后","authors":"Roham Hadidchi, Porsche Lee, Shawn Qiu, Sagar Changela, Sonya Henry, Tim Q Duong","doi":"10.1016/j.ebiom.2025.105778","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The long-term outcomes of patients with pre-existing coronary artery disease (CAD) after SARS-CoV-2 infection are unknown.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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.</p><p><strong>Interpretation: </strong>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.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":11494,"journal":{"name":"EBioMedicine","volume":"116 ","pages":"105778"},"PeriodicalIF":9.7000,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-term outcomes of patients with pre-existing coronary artery disease after SARS-CoV-2 infection.\",\"authors\":\"Roham Hadidchi, Porsche Lee, Shawn Qiu, Sagar Changela, Sonya Henry, Tim Q Duong\",\"doi\":\"10.1016/j.ebiom.2025.105778\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The long-term outcomes of patients with pre-existing coronary artery disease (CAD) after SARS-CoV-2 infection are unknown.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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.</p><p><strong>Interpretation: </strong>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.</p><p><strong>Funding: </strong>None.</p>\",\"PeriodicalId\":11494,\"journal\":{\"name\":\"EBioMedicine\",\"volume\":\"116 \",\"pages\":\"105778\"},\"PeriodicalIF\":9.7000,\"publicationDate\":\"2025-05-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"EBioMedicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ebiom.2025.105778\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"EBioMedicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ebiom.2025.105778","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
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.
EBioMedicineBiochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology
CiteScore
17.70
自引率
0.90%
发文量
579
审稿时长
5 weeks
期刊介绍：
eBioMedicine is a comprehensive biomedical research journal that covers a wide range of studies that are relevant to human health. Our focus is on original research that explores the fundamental factors influencing human health and disease, including the discovery of new therapeutic targets and treatments, the identification of biomarkers and diagnostic tools, and the investigation and modification of disease pathways and mechanisms. We welcome studies from any biomedical discipline that contribute to our understanding of disease and aim to improve human health.
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