COVID-19によって心筋梗塞・脳梗塞リスクが大幅に上昇
ウイルスには赤血球凝集作用を持つものは多いが、コロナウイルスもその一つである。
(2021/08/15 管理者記載)
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新型コロナウイルス感染症(COVID-19)は急性心筋梗塞および虚血性脳卒中のリスク因子であることが、スウェーデンにおけるCOVID-19の全症例を分析した自己対照ケースシリーズ(SCCS)およびマッチドコホート研究で示唆された。スウェーデン・ウメオ大学のIoannis Katsoularis氏らが報告した。COVID-19は多臓器を標的とした複雑な疾患であり、これまでの研究で、COVID-19が急性心血管系合併症の有力なリスク因子であることが浮き彫りになっていた。Lancet誌オンライン版2021年7月29日号掲載の報告。
スウェーデンのCOVID-19全患者約8万7千例を解析
研究グループは、2020年2月1日~9月14日の期間にスウェーデンでCOVID-19を発症したすべての患者の個人識別番号を特定し、入院、外来、がんおよび死因に関する登録とクロスリンクした。対照群は、年齢、性別、スウェーデンの居住地域でマッチングさせた。SCCSではCOVID-19全患者、マッチドコホート研究ではCOVID-19全患者とマッチングした対照者の入院原因は、急性心筋梗塞または虚血性脳卒中の国際疾病分類コードによって特定された。
SCCS研究では、COVID-19発症後の初回急性心筋梗塞または虚血性脳卒中の発生率比(IRR)を算出し対照期間と比較。マッチドコホート研究では、COVID-19発症後2週間以内における初回急性心筋梗塞または虚血性脳卒中の発症リスク増加を、マッチングし対照群と比較した。
解析対象は、SCCS研究でCOVID-19全患者8万6,742例、マッチドコホート研究でマッチングされた対照者34万8,481例であった。
急性心筋梗塞および虚血性脳卒中のリスクはCOVID-19発症後1週以内で約3倍
SCCS研究における初回急性心筋梗塞のIRRは、COVID-19発症日をリスク期間から除外した解析(解析1)では、COVID-19発症後1週間以内(1~7日)で2.89(95%信頼区間[CI]:1.51~5.55)、2週目(8~14日)で2.53(1.29~4.94)、3~4週目(15~28日)で1.60(0.84~3.04)、COVID-19発症日をリスク期間に含めた解析(解析2)では、それぞれ8.44(5.45~13.08)、2.56(1.31~5.01)、1.62(0.85~3.09)であった。
また、初回虚血性脳卒中のIRRは、解析1では、それぞれ2.97(95%CI:1.71~5.15)、2.80(1.60~4.88)、2.10(1.33~3.32)、解析2では6.18(4.06~9.42)、2.85(1.64~4.97)、2.14(1.36~3.38)であった。
マッチドコホート研究では、解析1の場合、COVID-19発症後2週以内の初回急性心筋梗塞のオッズ比(OR)は3.41(95%CI:1.58~7.36)、虚血性脳卒中は3.63(1.69~7.80)、解析2の場合、それぞれ6.61(3.56~12.20)、6.74(3.71~12.20)であった。
Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study
Ioannis Katsoularis, Osvaldo Fonseca-Rodríguez, Paddy Farrington, Krister Lindmark, Anne-Marie Fors Connolly
Lancet 2021 Jul 29; pii: S0140-6736(21)00896-5.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00896-5/fulltext
Abstract
BACKGROUND :
COVID-19 is a complex disease targeting many organs. Previous studies highlight COVID-19 as a probable risk factor for acute cardiovascular complications. We aimed to quantify the risk of acute myocardial infarction and ischaemic stroke associated with COVID-19 by analysing all COVID-19 cases in Sweden.
METHODS :
This self-controlled case series (SCCS) and matched cohort study was done in Sweden. The personal identification numbers of all patients with COVID-19 in Sweden from Feb 1 to Sept 14, 2020, were identified and cross-linked with national inpatient, outpatient, cancer, and cause of death registers. The controls were matched on age, sex, and county of residence in Sweden. International Classification of Diseases codes for acute myocardial infarction or ischaemic stroke were identified in causes of hospital admission for all patients with COVID-19 in the SCCS and all patients with COVID-19 and the matched control individuals in the matched cohort study. The SCCS method was used to calculate the incidence rate ratio (IRR) for first acute myocardial infarction or ischaemic stroke following COVID-19 compared with a control period. The matched cohort study was used to determine the increased risk that COVID-19 confers compared with the background population of increased acute myocardial infarction or ischaemic stroke in the first 2 weeks following COVID-19.
FINDINGS :
86 742 patients with COVID-19 were included in the SCCS study, and 348 481 matched control individuals were also included in the matched cohort study. When day of exposure was excluded from the risk period in the SCCS, the IRR for acute myocardial infarction was 2·89 (95% CI 1·51-5·55) for the first week, 2·53 (1·29-4·94) for the second week, and 1·60 (0·84-3·04) in weeks 3 and 4 following COVID-19. When day of exposure was included in the risk period, IRR was 8·44 (5·45-13·08) for the first week, 2·56 (1·31-5·01) for the second week, and 1·62 (0·85-3·09) for weeks 3 and 4 following COVID-19. The corresponding IRRs for ischaemic stroke when day of exposure was excluded from the risk period were 2·97 (1·71-5·15) in the first week, 2·80 (1·60-4·88) in the second week, and 2·10 (1·33-3·32) in weeks 3 and 4 following COVID-19; when day of exposure was included in the risk period, the IRRs were 6·18 (4·06-9·42) for the first week, 2·85 (1·64-4·97) for the second week, and 2·14 (1·36-3·38) for weeks 3 and 4 following COVID-19. In the matched cohort analysis excluding day 0, the odds ratio (OR) for acute myocardial infarction was 3·41 (1·58-7·36) and for stroke was 3·63 (1·69-7·80) in the 2 weeks following COVID-19. When day 0 was included in the matched cohort study, the OR for acute myocardial infarction was 6·61 (3·56-12·20) and for ischaemic stroke was 6·74 (3·71-12·20) in the 2 weeks following COVID-19.
INTERPRETATION :
Our findings suggest that COVID-19 is a risk factor for acute myocardial infarction and ischaemic stroke. This indicates that acute myocardial infarction and ischaemic stroke represent a part of the clinical picture of COVID-19, and highlights the need for vaccination against COVID-19.
FUNDING :
Central ALF-funding and Base Unit ALF-Funding, Region Västerbotten, Sweden; Strategic funding during 2020 from the Department of Clinical Microbiology, Umeå University, Sweden; Stroke Research in Northern Sweden; The Laboratory for Molecular Infection Medicine Sweden.