Long-term effects of myocardial injury on one-year outcomes in COVID-19 survivors: a prospective cohort study
W He, D WangAbstract
Background/Introduction
Myocardial injury is common in hospitalized COVID-19 patients and predicts acute adverse outcomes, but its long-term impact remains unclear.
Purpose
To evaluate the association of myocardial injury during hospitalization with one-year all-cause mortality, major adverse cardiovascular events (MACE), persistent symptoms, and quality of life in COVID-19 survivors.
Methods
This prospective cohort study included 2,185 COVID-19 survivors discharged from a tertiary hospital in China (December 2022 – March 2023). Myocardial injury was defined as high-sensitivity cardiac troponin I (hs-cTnI) >99th percentile upper reference limit (>26.2 pg/ml) during hospitalization. Patients were followed for one year after discharge. Primary outcomes were all-cause mortality and MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure). Secondary outcomes included persistent symptoms and health-related quality of life (EQ-5D-5L, EQ-VAS) assessed by structured questionnaires. Propensity score matching (PSM) and multivariable Cox regression were used to adjust for confounders.
Results
Of 2,185 patients, 531 (24.3%) had myocardial injury. At one year, patients with myocardial injury had higher all-cause mortality (15.8% vs. 4.9%; adjusted HR 3.14, 95% CI 2.31–4.27) and MACE (25.6% vs. 5.1%; adjusted HR 5.22, 95% CI 3.97–6.86) compared to those without injury, with consistent results after PSM. Long-term use of ACE inhibitors or angiotensin II receptor blockers (ACEI/ARB) was associated with lower mortality (HR 0.44, 95% CI 0.23–0.85) and MACE (HR 0.58, 95% CI 0.36–0.92) in the myocardial injury group. Among 2,020 survivors completing the questionnaire, 71.5% reported at least one persistent symptom; fatigue (25.3%) and sleep difficulties (16.4%) were most common. Myocardial injury survivors had higher symptom burden and lower EQ-VAS scores (median 80 vs. 85, P<0.001) than those without injury.
Conclusion(s)
Myocardial injury during COVID-19 hospitalization is independently associated with increased one-year mortality, MACE, persistent symptoms, and reduced quality of life. ACEI/ARB therapy may improve outcomes in these patients. These findings highlight the need for targeted post-discharge management and long-term cardiovascular monitoring in COVID-19 survivors with myocardial injury.Graphical abstract