Ischemic Heart Disease After SARS-CoV-2 Infection: A Cross-Sectional Study

BACKGROUND: The incidence of newly diagnosed stable angina after a SARS-CoV-2 infection remains high. However, studies on the clinical, functional, and laboratory characteristics of this disease are inadequate. The manifestations of ischemic heart disease (IHD) following SARS-CoV-2 infection require further investigation to elucidate the pathophysiological mechanisms and personalize follow-up care.

AIM: This study aimed to compare the clinical, functional, laboratory, and angiographic characteristics of stable angina in patients diagnosed with IHD following SARS-CoV-2 infection.

METHODS: This cross-sectional study assessed patients’ medical histories, along with clinical, laboratory, and instrumental findings. The study enrolled 428 patients with stable IHD and documented SARS-CoV-2 infection (within 3–18 months of the onset of the disease). Group 1 (n = 195) consisted of patients with newly diagnosed IHD, and group 2 (n = 233) included patients with previously diagnosed IHD, with the infection being documented to have occurred ≥12 weeks prior to study enrollment. IHD was diagnosed through a comprehensive evaluation that included clinical presentation, electrocardiographic analysis, echocardiographic imaging, stress tests, and coronary angiography. Blood chemistry was performed using standardized methods. Statistical analysis was carried out in RStudio. Continuous variables were compared using the Mann–Whitney U test, whereas the comparison of binary and categorical variables was conducted using Fisher’s exact test. The critical significance level was set at p = 0.05.

RESULTS: Group 1 was significantly younger (p = 0.009), had a lower body mass index (p < 0.001), and had a shorter history of hypertension (p < 0.001). These patients exhibited higher prevalence of functional class I angina pectoris (p = 0.006), NYHA class II chronic heart failure (p = 0.005), and lower prevalence of ventricular extrasystole (p = 0.002). Coronary angiography demonstrated that group 1 showed higher prevalence of unchanged coronary arteries (p = 0.003) and hemodynamically insignificant stenoses (p = 0.018), but lower proportion of hemodynamically significant stenoses (p < 0.001). There were no significant differences found in the occurrence of multifocal atherosclerosis (p = 0.132). The treadmill test revealed comparable positive results across both groups (p = 0.479). However, group 1 exhibited a higher frequency of inconclusive results (p = 0.011). The laboratory profile of patients from group 2 showed increased Lp(a) (p = 0.023), triglycerides (p = 0.003), apoB (p = 0.022), NT-proBNP (p = 0.010), D-dimer (p = 0.001), high sensitivity C-reactive protein (p = 0.012), and cystatin C (p = 0.001), as well as higher fasting glucose (p = 0.030), but comparable HbA1c levels (p = 0.750).

CONCLUSION: Patients who develop stable angina following SARS-CoV-2 infection demonstrate a less severe clinical and functional phenotype, less significant coronary atherosclerosis, and more favorable biomarker profile than those with previously diagnosed IHD who had SARS-CoV-2 infection.