Two-Year Follow-Up of Patients with Myocardial Injury During Acute COVID-19: Insights from the CARDIO COVID 20-21 Registry

Juan Pablo Arango-Ibanez^1,2Brayan Daniel Cordoba-Melo^1,2Mario Miguel Barbosa Rengifo^1,2Jesika Daniela Tobar-Arteaga²Maria Lucia Castro-Trujillo²Cesar José Herrera³Miguel Ángel Quintana Da Silva⁴Andrés Felipe Buitrago Sandoval⁵María Lorena Coronel Gilio⁶Freddy Pow Chon Long⁷Liliana Cárdenas Aldaz⁸Andrea Valencia¹Carlos Enrique Vesga-Reyes^1,2Juan Esteban Gómez-Mesa^1,2*

• ¹Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Cauca, Colombia
• ²Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Cauca, Colombia
• ³Departamento de Cardiología, Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina (CEDIMAT), Santo Domingo, Distrito Nacional, Dominican Republic
• ⁴Departamento de Cardiología, Instituto Cardiovascular Sanatorio MIGONE, Asunción, Paraguay
• ⁵Departamento de Cardiología, Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
• ⁶Departamento de Cardiología, Instituto de Cardiología J. F. Cabral, Corrientes, Argentina
• ⁷Departamento de Cardiología, Hospital Luis Vernaza, Guayaquil, Guayas, Ecuador
• ⁸Departamento de Cardiología, Hospital de Especialidades Eugenio Espejo, Quito, Pichincha, Ecuador

Introduction: COVID-19 can cause Myocardial Injury (MI) during acute illness, which has been strongly associated with worse outcomes during hospitalization, however, more research is required on its effects on long-term outcomes, especially in underexplored regions in the literature such as Latin America.Methodology: This multicenter prospective cohort study follows up with patients with previous severe COVID-19 at a 2-year follow-up encounter. Comprehensive assessments were conducted includ ing demographic data, clinical variables, psychiatric evaluations, and echocardiographic studies. Patients were stratified by the presence or absence of MI during their acute COVID-19 hospitalizatio n.Statistical analyses included logistic regression and univariate comparisons.Results: Of the 210 patients included, 53 (25%) had MI. Patients with MI were older, had a higher prevalence of comorbidities (e.g., hypertension, chronic kidney disease, atrial fibrillation), and were more likely to require intensive care unit admission, invasive mechanical ventilation, and vasopressor or inotropic support during acute COVID-19. Regarding long-term cardiovascular outcomes, no significant differences were observed in de novo cardiovascular disease, venous thromboembolism, or acute cardiovascular events. Patients with MI had greater odds of cardiopulmonary hospitalizatio ns during follow-up (aOR 3.67, 95% CI 1.07-13.07, p=0.037) after adjusting for age and sex.Patients with prior MI during COVID-19 had a higher prevalence of comorbidities, poorer functional status, and increased odds of cardiopulmonary hospitalizations over a two-year follow-up evaluation compared to those without MI. Although prior studies suggest an association between MI and worse long-term outcomes, the evidence remains inconsistent. These findings emphasize the need for ongoing research to clarify how MI contributes to worsened long-term outcomes.