Long-Term Major Adverse Cardiovascular Events in Patients with Moderate and Severe COVID-19: A Focus on Early Statin Use and Previous CVD

Arezoo Khosravi; Saeed Ghodsi; Mohammadreza Memarjafari; Alireza Nematollahi; Reza Sheikh-Sharbafan; Seyed-Ali Sadre-Bafghi; Seyed-Vahid Moosavi; Mansour Abdollahzadeh; Arash Jalali; Maryam Moshkani Farahani

doi:10.18502/jthc.v18i3.14113

Long-Term Major Adverse Cardiovascular Events in Patients with Moderate and Severe COVID-19: A Focus on Early Statin Use and Previous CVD

J Tehran Heart Cent. 2023 Jul;18(3):183-195. doi: 10.18502/jthc.v18i3.14113.

Affiliations

¹ Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
² Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Afshar Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Abstract

Background: Limited data exist regarding the status of long-term cardiovascular disease (CVD) outcomes of hospitalized COVID-19 patients. We aimed to examine the efficacy of early statin use after SARS-CoV-2 pneumonia and the impact of prior CVD on the incidence of cardiovascular events.

Methods: A prospective cohort study was performed on hospitalized COVID-19 patients. The primary endpoint was major adverse cardiovascular events (MACE) as a composite of cardiovascular mortality, stroke, heart failure, venous thromboembolism (VTE), revascularization, and nonfatal myocardial infarction (MI). The secondary endpoints comprised MACE components, all-cause mortality, readmission for COVID-19, and impaired functional classes.

Results: The mean age of the 858 participants was 55.52±13.97 years, and the median follow-up time was 13 months (11.5-15). Men comprised 63.9% of the patients. Overall, MACE occurred in 84 subjects (9.8%), and 98 patients (11.4%) received ventilation. A multivariate Cox regression model was employed to explore the association between statin use and outcomes, and the following hazard ratios were obtained: MACE (0.831 [0.529 to 0.981]; P=0.044), All-cause mortality (1.098 [0.935 to 1.294]; P=0.255), stroke (0.118 [0.029 to 0.48]; P=0.003), revascularization (0.103 [0.029 to 0.367]; P<0.0001), poor functional capacity (0.827 [0.673 to 1.018]; P=0.073), nonfatal MI (0.599 [0.257 to 1.394]; P=0.234), VTE (0.376 [0.119 to 1.190]; P=0.096), and decompensated heart failure (0.137 [0.040 to 0.472]; P=0.002). Prior CVD predicted MACE (2.953 [1.393 to 6.271]; P=0.005), all-cause death (1.170 [0.960 to 1.412]; P=0.102), and VTE (2.770 [0.957 to 8.955]; P=0.051).

Conclusion: Previous CVD is a robust predictor of long-term MACE and VTE. Early statin use might decrease the incidence rates of MACE, ischemic stroke, revascularization, and readmission for heart failure.

Keywords: COVID-19; Cardiovascular disease; Long term adverse effects; Mortality; Statin; Survival.