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The Impacts of Nirmatrelvir–Ritonavir on Myocardial Injury and Long-Term Cardiovascular Outcomes in Hospitalized Patients with COVID-19 amid the Omicron Wave of the Pandemic

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Abstract

Purpose

Even though nirmatrelvir–ritonavir can improve the short-term morbidity and mortality in COVID-19 patients, the effects of this treatment on long-term major adverse cardiovascular events (MACEs), especially myocardial injury, remains undetermined.

Methods

This prospective cohort study identified hospitalized adult patients with COVID-19 between April 19, 2022, and June 9, 2022, amid the omicron wave of the pandemic. Matched nirmatrelvir–ritonavir-treated and non-treated cohorts were formed using the propensity score matching method. The primary outcome of this study was the incidence of MACEs (cardiovascular death, myocardial infarction, stroke, new-onset heart failure or heart failure hospitalization or ventricular arrhythmia) from 30 days to 16 months after the diagnosis of COVID-19.

Results

Two 949-patient cohorts with balanced baseline characteristics were formed by propensity score matching. Patients with nirmatrelvir–ritonavir, compared to those untreated, had a lower level of troponin I peak as well as the incidence of troponin I elevation. During the follow-up period, 59 patients in the nirmatrelvir–ritonavir group and 86 patients in the control group developed MACEs (P = 0.020). Regarding specific constituents of MACEs, the differences are mainly reflected in new-onset heart failure or heart failure hospitalization. COVID-19 clinical severity and troponin I peak were the independent predictors, while nirmatrelvir–ritonavir was the independent protective factor for the occurrence of MACEs in this population.

Conclusion

Nirmatrelvir–ritonavir was effective in reducing myocardial injury as well as long-term adverse cardiovascular outcomes among hospitalized patients with COVID-19 amid the omicron wave of the pandemic.

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Data Availability

Requests for data collected for the study can be made to the co-corresponding author and will be considered individually.

Code Availability

Not applicable.

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Funding

This study was supported by the Clinical Research Program of Shanghai Ninth People’s Hospital (JYLJ202209) and Shanghai Municipal Health Commission (202240149).

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Authors and Affiliations

  1. Department of Cardiology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, People’s Republic of China

    Jun Gu, Zhi-Hua Han, Chang-qian Wang & Jun-feng Zhang

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  1. Jun Gu
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  2. Zhi-Hua Han
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  3. Chang-qian Wang
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  4. Jun-feng Zhang
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Contributions

JG: concept of the study, design, data analysis, interpretation of the results, and drafting of the manuscript. ZHH: data analysis, interpretation of the results. JFZ: data extraction and interpretation. CQW: infrastructure support, data interpretation. All authors agreed with the final version of the manuscript.

Corresponding authors

Correspondence to Jun Gu or Jun-feng Zhang.

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All aspects of conducting the study, including the consent process and collection of the assessments used in this analysis, were approved by institutional ethics review boards.

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Informed consent was obtained from all individual participants included in the study.

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Gu, J., Han, ZH., Wang, Cq. et al. The Impacts of Nirmatrelvir–Ritonavir on Myocardial Injury and Long-Term Cardiovascular Outcomes in Hospitalized Patients with COVID-19 amid the Omicron Wave of the Pandemic. Cardiovasc Drugs Ther (2024). https://doi.org/10.1007/s10557-024-07570-4

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