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(A) All-cause death time-to-event curve. (B) Six months follow-up cardiovascular outcomes. ACS, acute coronary syndrome; CV, cardiovascular; HFH, heart failure hospitalization; PE, pulmonary embolism.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronavirus disease 2019 (COVID-19) has become the most important public health issue worldwide due to its rapid spread, morbidity, and mortality. Although its main target is the respiratory system, a significant proportion of COVID-19 patients exhibits myocardial injury, which is associated with a worse in-hospital prognosis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3</span></a> The pathophysiological mechanisms related to cardiovascular affectation are not entirely understood but may be related to intense endothelial damage, inflammation, thrombosis, and coagulopathy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> However, it is unknown if COVID-19 may affect the mid and long-term cardiovascular outcomes. We aim to describe the cardiovascular outcomes at six months following COVID-19 diagnosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This is a single-center, retrospective registry of all consecutive hospitalized patients who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 from March 1 to April 19, 2020, at the University Hospital Hospital Clínic, Barcelona, Spain. The study was approved by the Ethics Committee and adhered to the principles outlined in Helsinki's Declaration.</p><p id="par0015" class="elsevierStylePara elsevierViewall">All information was obtained from electronic records (medical history and national social security database). Patients were divided into two groups according to the RT-PCR result to have a comparator arm. Rates of all-cause death and cardiovascular outcomes (cardiovascular death, acute coronary syndrome [ACS], stroke, heart failure hospitalization [HFH], and pulmonary embolism [PE]) were evaluated at 6-month follow-up and compared between groups. Endpoints were defined according to the Academic Research Consortium-2.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> A Cox proportional hazards model along with a Wald test was used for comparison of outcomes. A crude analysis was performed for all endpoints, and adjusted analysis was performed only for all-cause death. Kaplan–Meier curves were used to derive the event rates at follow-up and to plot time-to-event curves. Patients not eligible for six-month follow-up were considered at risk until the date of last follow-up, at which point they were censored. A two-side <span class="elsevierStyleItalic">p</span>-value <0.05 was considered statistically significant. All data were processed using the Statistical Package for Social Sciences, version 25.0 (SPSS Inc., Chicago, IL, USA).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 865 individuals were included in the study, divided into 620 with COVID-19 and 245 without COVID-19. Patients with COVID-19 were older (59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.6 years vs. 45<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.5 years, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), more frequently male (333 [53.7%] vs. 112 [45.7%], <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.034), with higher body mass index (BMI) (27.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0 vs. 24.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) compared with patients without. Furthermore, patients with COVID-19 had higher rates of hypertension (237 [38.2%] vs. 43 [17.6%], <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), diabetes mellitus [94 (15.2%) vs. 6 (2.4%), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001], and hypercholesterolemia [161 (26%) vs. 23 (9.4%), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001] as compared to non-COVID-9 counterparts.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with COVID-19 had a higher risk of all-cause death compared to those without (15.6% [97/620] vs. 4.1% [10/245], adjusted HR: 2.82, [95% CI: 1.13–7.75], <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.026) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Of note, this difference was driven by a higher risk of in-hospital all-cause death (13.9% vs. 1.6%, un-adjusted HR: 9.10 [95% CI 3.34–24.80], <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), with no differences in post-discharge risk of all-cause death between patients with or without COVID-19 (2.1% [11/534] vs. 2.5% [6/241], un-adjusted HR: 0.85 [95% CI 0.31–2.28], <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.739). Furthermore, at 6-month follow-up, cardiovascular death and PE rates were higher in COVID-19 patients than those without. Nevertheless, these differences were due to a higher rate of in-hospital cardiovascular death (2.3% vs. 0%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018) and PE (3.4% vs. 0%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), without differences in the post-discharge follow-up. The in-hospital ACS rate was higher in patients with COVID-19 than those without (3.4% vs. 0.4%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.008). At 6-month, there were no differences in ACS between patients with or without COVID-19. Ultimately, there were no differences in stroke or HFH (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">At 6-month follow-up, we found a higher risk of all-cause death in COVID-19 patients. However, the difference between the groups was driven by a higher in-hospital all-cause death risk, without an increased risk during the post-discharge follow-up. Our data suggest that COVID-19 infection could be related to adverse acute cardiovascular outcomes without impaired outcomes beyond the disease's acute phase. Larger registries with extended follow-up must be performed to determine the long-term effect of COVID-19 on the cardiovascular system.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study has been funded by <span class="elsevierStyleGrantSponsor" id="gs1">Carlos III Institute</span>, Madrid, Spain [Research grant <span class="elsevierStyleGrantNumber" refid="gs1">COV20/00040</span>].</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Both authors equally contributed to this paper.</p>" "identificador" => "fn1" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 1500 "Tamanyo" => 179042 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">All-cause death and cardiovascular outcomes at six months follow-up in patients with or without COVID-19. (A) All-cause death time-to-event curve. (B) Six months follow-up cardiovascular outcomes. ACS, acute coronary syndrome; CV, cardiovascular; HFH, heart failure hospitalization; PE, pulmonary embolism.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19 and the cardiovascular system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y.Y. Zheng" 1 => "Y.T. Ma" 2 => "J.Y. Zhang" 3 => "X. Xie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41569-020-0360-5" "Revista" => array:7 [ "tituloSerie" => "Nat Rev Cardiol" "fecha" => "2020" "volumen" => "17" "paginaInicial" => "259" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32139904" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S014067360860269X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Shi" 1 => "M. Qin" 2 => "B. Shen" 3 => "Y. Cai" 4 => "T. Liu" 5 => "F. 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Spertus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.117.029289" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2018" "volumen" => "137" "paginaInicial" => "2635" "paginaFinal" => "2650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29891620" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015800000001/v2_202201200752/S2387020621006720/v2_202201200752/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015800000001/v2_202201200752/S2387020621006720/v2_202201200752/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006720?idApp=UINPBA00004N" ]
Journal Information
Vol. 158. Issue 1.
Pages 41-42 (January 2022)
Vol. 158. Issue 1.
Pages 41-42 (January 2022)
Scientific letter
Mid-term effects of SARS-CoV-2 infection on cardiovascular outcomes
Efectos cardiovasculares a medio plazo de la infección por SARS-CoV-2
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