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

Arezoo Khosravi Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Saeed Ghodsi Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Mohammadreza Memarjafari Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Alireza Nematollahi Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Reza Sheikh-Sharbafan Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Seyed-Ali Sadre-Bafghi Afshar Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Seyed-Vahid Moosavi Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Mansour Abdollahzadeh Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Arash Jalali Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Maryam Moshkani Farahani Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v18i3.14113

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

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.