ABSTRACT
Background: Patients with COVID-19 have an increased risk of cardiovascular adverse events during the acute phase. However, the long-term cardiovascular outcomes are unknown. Objective(s): We aimed to determine the long-term effects of COVID-19 in the cardiovascular system. Method(s): This is a multicenter, observational, retrospective registry conducted at 17 centers in Spain and Italy. Consecutive patients older than 18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 in the participating institutions were included. Patients were classified into two groups, according to the results of the RT-PCR: COVID-19 positive or negative. The primary outcome was cardiovascular (CV) death at 1-year. The secondary outcomes included acute myocardial infarction, stroke, heart failure hospitalization, pulmonary embolism, and serious cardiac arrhythmias at 1-year. Outcomes were compared between the two groups. An independent clinical event committee adjudicated events. Result(s): A total of 4427 patients were included, 3578 (80.8%) patients with COVID-19 and 849 (19.2%) without COVID-19. COVID-19 patients were older, had a higher rate of classical cardiovascular risk factors, except for active smoking, and had fewer comorbidities. At a median time of 13.5 (IQR 11.8-15.8) months, after an adjustment by baseline characteristics, there was no difference in CV death (1.4% vs. 1.1%;HR 1.03 [0.49-2.18];p=0.941) between patients with COVID-19 and without. However, COVID- 19 patients experienced higher rate of venous thromboembolism (VTE) (3.9% vs. 0.6%, HR 6.11 [2.46-15.16];p=0.001), major bleeding (2.9% vs. 0.5%, HR 5.38 [1.95-14.84];p=0.001), and serious cardiac arrhythmias (2.6% vs. 0.9%, HR 2.25 [1.07-4.73];p=0.033). During follow-up, between discharge and end of follow-up, COVID-19 patients did not experience a higher risk of adverse cardiovascular outcomes (composite of CV death, any MI, ischemic stroke, systemic arterial thrombosis, VTE, heart failure hospitalization, or any serious arrhythmia) compared to patients without (HR 0.80;[0.53-1.21];p=0.298). Conclusion(s): At 1-year follow-up, COVID-19 was not associated with an increased risk of cardiovascular death but with a higher risk of VTE events, major bleeding, and serious cardiac arrhythmias. COVID-19 was not associated with a higher risk of adverse cardiovascular events during follow-up.
ABSTRACT
Background: In the coronavirus disease-2019 (COVID-19) pandemic, elderly people with cardiovascular risk factors and/or cardiovascular disease have been the most seriously affected. We sought to evaluate the impact of the pandemic, due to both the social confinement and the infection itself, in the population of patients older than 75 years of age with previous percutaneous coronary revascularization. Methods: A subgroup of patients from the SIERRA 75 registry were included in the study. This is a prospective registry of patients older than 75 years undergoing percutaneous revascularization in 42 centers in Spain and Portugal. The follow-up of the patients has been updated, covering the entire period of outbreak and confinement (March 14–May 10, 2020) through direct telephone contact to carry out a specific questionnaire for patients and their relatives. In addition, all electronic health records have been reviewed. Results: A total of 709 patients have been included, of whom 17 had died in the 12.5 ± 3.4 months follow-up before the start of the outbreak and lockdown. Therefore, 692 patients were followed during the study period (mean age of 80.8 ± 4.2 years, 37% women). During this period, 11 (1.6%) had confirmed COVID-19 (age 81.2 ± 5 years, 36% women) of which 8 were admitted to the hospital but none in the intensive care unit. Among the 11 cases, 2 (18%) died, an 80-year-old man and a 76-year-old woman, both in Hospital. COVID-19 incidence was higher than in the global population in the region (1.6% vs. 0.4%;p < 0.0001). During this period of confinement, 91 patients (13%) presented cardiac symptoms (21 stable angina, 82 dyspnea, and 6 syncope). Medical attention was demanded by 43 (6.2%), of whom 22 were admitted in hospitals. There were 4 cases with acute coronary syndrome and 4 underwent revascularization. Death was reported in 7 (1%) patients (2 due to COVID-19, 4 due to cardiovascular disease, and 1 due to multiple pathologies). The monthly mortality rate in this period was 2.6 times higher than in the previous months. Outpatient visits were canceled in 119 cases (17%) but 108 were contacted by phone. Conclusion: In this elderly population with coronary artery disease revascularized before the pandemic, an increase in cardiovascular and general morbidity as well as in total mortality was observed during the outbreak and confinement period. Incidence of COVID-19 was higher than in the general population. Mortality among COVID-19 patients was very high. Categories: OTHER: COVID-19
ABSTRACT
Background: In the COVID-19 pandemic, elderly people with cardiovascular risk factors and/or cardiovascular disease have been the most seriously affected. We sought to evaluate the impact of the pandemic, due to both the social confinement and the infection itself, in the population of patients older than 75 years of age with previous percutaneous coronary revascularization. Methods: A subgroup of patients from the SIERRA 75 registry were included in the study. This is a prospective registry of patients older than 75 years undergoing percutaneous revascularization in 42 centers in Spain and Portugal. The follow-up of the patients has been updated, covering the entire period of outbreak and confinement (March 14 to May 10) through direct telephone contact to carry out a specific questionnaire for patients and their relatives. In addition, all electronic health records have been reviewed. Results: A total of 709 patients have been included. Among those, 17 had died in the 12.5 ± 3.4 months follow-up prior to the start of the outbreak-confinement period. Therefore, 692 patients were followed during the study period: (mean age of 80.8 ± 4.2 years, 37% were women, 83% with hypertension, 44% with diabetes, 75% with previous STEMI/NSTEMI, 100% with previous PCI). During this period, 11 (1.6%) had confirmed COVID-19 (age 81.2 ± 5 years, 36% women). Eight were admitted to the hospital but none in the ICU. Among the 11 cases, 2 (18%) died, an 80-year-old man and a 76-year-old woman, both in the hospital. COVID-19 incidence was higher than in the global population in the region (1.6% vs. 0.4%;p < 0.0001). During this period of confinement, 91 patients (13%) presented cardiac symptoms (21 stable angina, 82 dyspnea and 6 syncope). Medical attention was demanded by 43 (6.2%), of whom 22 were admitted to the hospital. There were 4 (0.6%) cases with acute coronary syndrome and 4 (0.6%) underwent revascularization. Death was reported in 7 (1%) patients (2 due to COVID-19, 4 due to cardiovascular disease, and 1 due to multiple pathologies). The monthly mortality rate in this period was 2.6 times higher than in the previous months. Outpatient visits were canceled in 119 cases (17%) but 108 were contacted by phone. Conclusion: In this elderly population with coronary artery disease revascularized before the pandemic, an increase in cardiovascular and general morbidity as well as in total mortality was observed during the outbreak and confinement. Incidence of COVID-19 was higher than in the general population. Mortality among COVID-19 patients was very high. Categories Other: COVID-19