心肌损伤在COVID-19住院患者中普遍存在。然而,COVID-19疫苗在改变心肌损伤风险方面的作用尚不清楚.
评估疫苗在改变COVID-19心肌损伤风险中的作用。
我们纳入了2021年3月至2022年2月收治的COVID-19患者,这些患者在入院后30天内具有已知的疫苗接种状态,且hs-cTnI评估≥1。主要终点是心肌损伤的发生(hs-cTnI水平>第99百分位参考上限)。
纳入1019例患者(平均年龄67.7±14.8岁,60.8%男性,34.5%接种了COVID-19疫苗)。145例(14.2%)患者发生心肌损伤。在多变量逻辑回归分析中,高龄,慢性肾病和高血压,但不是疫苗接种状态,是心肌损伤的独立预测因子。在根据年龄三元分布的分析中,与其他三元组(I三元组:≤60岁;II三元组:61~75岁)相比,III三元组(≥76岁)的心肌损伤发生率更高(p<0.001).此外,在第三界,接种疫苗对心肌损伤具有保护作用(OR0.57,CI95%0.34-0.94;p=0.03),而既往冠心病史是独立的阳性预测因子。相比之下,在ITertile中,慢性肾脏病(OR6.94,95%CI1.31-36.79,p=0.02)和疫苗接种(OR4.44,95%CI1.28-15.34,p=0.02)是心肌损伤的独立阳性预测因子.
在≥76岁的患者中,COVID-19疫苗对心肌损伤的发生具有保护作用,而在≤60岁的患者中,心肌损伤与以前的COVID-19疫苗接种有关.需要进一步的研究来澄清潜在的机制。
Myocardial injury is prevalent among patients hospitalized for COVID-19. However, the role of COVID-19 vaccines in modifying the risk of myocardial injury is unknown.
To assess the role of vaccines in modifying the risk of myocardial injury in COVID-19.
We enrolled COVID-19 patients admitted from March 2021 to February 2022 with known vaccination status and ≥1 assessment of hs-cTnI within 30 days from the admission. The primary endpoint was the occurrence of myocardial injury (hs-cTnI levels >99th percentile upper reference limit).
1019 patients were included (mean age 67.7±14.8 years, 60.8% male, 34.5% vaccinated against COVID-19). Myocardial injury occurred in 145 (14.2%) patients. At multivariate logistic regression analysis, advanced age, chronic kidney disease and hypertension, but not vaccination status, were independent predictors of myocardial injury. In the analysis according to age tertiles distribution, myocardial injury occurred more frequently in the III tertile (≥76 years) compared to other tertiles (I tertile:≤60 years;II tertile:61-75 years) (p<0.001). Moreover, in the III tertile, vaccination was protective against myocardial injury (OR 0.57, CI 95% 0.34-0.94; p=0.03), while a previous history of coronary artery disease was an independent positive predictor. In contrast, in the I tertile, chronic kidney disease (OR 6.94, 95% CI 1.31-36.79, p=0.02) and vaccination (OR 4.44, 95% CI 1.28-15.34, p=0.02) were independent positive predictors of myocardial injury.
In patients ≥76 years, COVID-19 vaccines were protective for the occurrence of myocardial injury, while in patients ≤60 years, myocardial injury was associated with previous COVID-19 vaccination. Further studies are warranted to clarify the underlying mechanisms.