Long‐Term Effects of Myocardial Injury on 1‐Year Outcomes in Hospital Survivors With COVID‐19: A Prospective Cohort Study

ABSTRACT

Myocardial injury is both a common complication among hospitalized coronavirus disease 2019 (COVID‐19) patients and a major predictor of adverse clinical outcomes. However, its long‐term effects remain poorly defined. In this prospective cohort study of 2185 COVID‐19 survivors (531 with myocardial injury), we assessed 1‐year post‐discharge outcomes using Kaplan–Meier analysis and multivariable Cox regression before and after propensity score matching. Myocardial injury was associated with higher all‐cause mortality (adjusted hazard ratio [aHR] 3.14) and major adverse cardiovascular events (MACE) (aHR 5.22). Long‐term use of angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) was associated with reduced mortality (aHR 0.44) and MACE (aHR 0.58) in the myocardial injury group. At 1 year, 71.5% of survivors reported persistent symptoms—most commonly fatigue and sleep difficulties—and those with myocardial injury had poorer quality of life. This study provides the prospective evidence from China's Omicron era on the prognostic value of myocardial injury, combining hard clinical endpoints with patient‐reported outcomes and the first analysis of the ACEI/ARB association in this population. These findings highlight the prognostic importance of myocardial injury and the potential role of ACEI/ARB therapy in post‐discharge management, supporting targeted follow‐up strategies for this high‐risk population.