長新冠與重大心血管不良事件及死亡率之關聯性：一項真實世界數據世代研究

研究目的：在後疫情時代，長新冠（Long COVID）對公共衛生構成沉重的負擔。超過三分之一的患者在確診COVID-19後的三至六個月，仍持續有相關症狀。過往文獻指出，因肺炎住院會增加罹患心血管疾病的風險。因此長新冠可能導致心血管疾病的觀點頻繁被提出，然而目前鮮少有研究評估長新冠與重大心血管不良事件（major cardiovascular events, 以下簡稱MACE）乃至死亡率之間的關聯。本研究旨在填補此一研究空白。我們利用TriNetX資料庫建立了一項回顧性世代研究（retrospective cohort study），探討新冠長期症狀、MACE及死亡率之關聯性。研究方法及資料：本研究採回顧性世代研究設計，利用來自 TriNetX資料庫的多中心真實世界電子病歷進行分析。研究納入 2020年至2023年間確診COVID-19之18 歲（含）以上患者。暴露組為首次確診COVID-19後3至6個月內被診斷出長新冠之患者，對照組則為未有長新冠診斷之COVID-19患者。主要評估預後為MACE的發生風險與全因死亡率。追蹤期間自指標日（Index date）後90天起算，直至發生研究設定之結果事件或最後一次醫療紀錄日期為止。研究結果：研究結果顯示，相較於未罹患長新冠之對照組，長新冠組發生MACE的風險顯著較高，其整體危險比（Hazard ratio, HR）為4.48（95% 信賴區間 [CI]：3.95–5.07）。在特定心血管疾病方面，冠狀動脈疾病與中風的危險比尤其顯著，分別高達6.48（95% CI：5.29–7.95）與 3.46（95% CI：2.96–4.04）。此外，長新冠組的死亡率亦顯著高於對照組，其危險比為1.53（95% CI：1.38–1.69）。結論與建議：和未罹患長新冠的COVID-19患者相比，長新冠患者未來併發MACE風險有顯著增加的趨勢。此發現可為臨床上針對長新冠患者進行長期心血管風險評估與照護提供重要參考。

Objective：Long COVID poses a great burden in public health in post-pandemic era. More than one third of patients experience long COVID symptoms between three and six months after being diagnosed with COVID-19. Previous study has showed that hospitalization with pneumonia increased the risk of cardiovascular disease. Consequently, the idea that long COVID may result in cardiovascular disease has been frequently suggested, However, there are few studies evaluating the association between long COVID and major cardiovascular events(MACE) and even deaths. We tried to fill this gap. We use TriNetX health care database to establish a retrospective cohort study dealing with the association of long-COVID and MACE & mortality.Methods and materials：This retrospective cohort study utilized multicenter real-world data from the TriNetX research network platform, which contains electronic health records from multiple healthcare organizations. Patients aged 18 years and older who were diagnosed with COVID-19 between 2020 and 2023 were included. The exposure group comprised individuals diagnosed with long-COVID within 3 to 6 months after their initial COVID-19 diagnosis, while the comparison group included COVID-19 patients without a diagnosis of long-COVID. The primary outcomes were the risk of major adverse cardiovascular events (MACE) and all-cause mortality. Follow-up commenced 90 days after the index date and continued until the occurrence of the study outcome or the date of the last available medical record.Results：The risk of MACE was markedly higher in the long-COVID cohort compared to the non-long-COVID cohort. The overall hazard ratio (HR) for MACE was 4.48 (95% CI: 3.95–5.07). Specific conditions such as coronary artery disease and stroke exhibited particularly high HRs, at 6.48 (5.29–7.95) and 3.46 (2.96–4.04) respectively. Mortality was significantly higher in the long-COVID group, with an HR of 1.53 (1.38–1.69). Conclusions Compared to patients without long COVID, patients with long COVID had a higher risk of developing MACE.Conclusion and suggestion：Compared to patients without long COVID, patients with long COVID had a higher risk of developing MACE.