PLoS ONE (Jan 2022)

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

  • Luis Ortega-Paz,
  • Victor Arévalos,
  • Diego Fernández-Rodríguez,
  • Víctor Jiménez-Díaz,
  • Jordi Bañeras,
  • Gianluca Campo,
  • Miguel Rodríguez-Santamarta,
  • José Francisco Díaz,
  • Claudia Scardino,
  • Zaira Gómez-Álvarez,
  • Alberto Pernigotti,
  • Fernando Alfonso,
  • Ignacio J Amat-Santos,
  • Antonio Silvestro,
  • Lorenzo Rampa,
  • José M de la Torre Hernández,
  • Gabriela Bastidas,
  • Josep Gómez-Lara,
  • Behnood Bikdeli,
  • Hector M García-García,
  • Dominick J Angiolillo,
  • Josep Rodés-Cabau,
  • Manel Sabaté,
  • Salvatore Brugaletta,
  • CV COVID-19 registry investigators

DOI
https://doi.org/10.1371/journal.pone.0279333
Journal volume & issue
Vol. 17, no. 12
p. e0279333

Abstract

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BackgroundThe long-term cardiovascular (CV) outcomes of COVID-19 have not been fully explored.MethodsThis 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).ResultsA 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).ConclusionsAt 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 registrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT04359927.