Adjudicated cardiovascular events in a cotemporary multicenter cohort of patients with COVID-19: findings from the CORONA-VTE Registry

Abstract

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with excess risk of cardiovascular events in the early post-infection period and during convalescence. Despite the progress in our understanding of cardiovascular complications, uncertainty persists with respect to contemporary event rates particularly given the change in viral variants and COVID-19 therapies, as well as availability of vaccines in later months of the pandemic. Purpose To report the cardiovascular complications of COVID-19, and assess results by vaccination status from a large multicenter patient-level US registry. Methods Adult patients with polymerase chain reaction-confirmed COVID-19 who received inpatient or outpatient care at Mass-General Brigham (MGB) Health system, the largest health system in Massachusetts that serves 1.5 million patients, were eligible for inclusion. Data elements were entered into a centralized database by trained research staff. Each clinical event was adjudicated by two independent physicians. The primary outcome was major cardiovascular events, defined as venous or arterial thrombosis, myocarditis or heart failure with inpatient treatment, new atrial fibrillation/flutter, or cardiovascular death. Outcomes were assessed at 30- and 90-day follow-up, shown as cumulative incidence, represented by subdistribution hazard functions. Findings were pre-specified to be assessed separately for patients who were hospitalized with COVID-19 vs outpatients. Vaccination status was ascertained for subgroup-specific analyses. Results The study included 4,123 patients from the MGB Health System from 3/13/2020 through 06/03/2022 (mean age: age: 53.5 ± 18 years; 55.9% female, Table). Among hospitalized patients, the cumulative incidence of primary outcome was 17.4% at day 30 (95% CI: 15.2-19.5%). Respective 30-day event rates for outpatients were 1.1% (95% CI: 0.7%-1.5%) (Figure, Panel A). Cumulative incidence of 30-day outcomes based on vaccination status (restricted to cohort from 12/14/2020 onward) is summarized in Panel B. Conclusions This multicenter study suggests that 30-day adjudicated cardiovascular events were frequent in hospitalized patients with COVID-19, although event rates were lower in vaccinated patients. Follow-up for 90-day outcomes is being finalized and will be presented at ESC 2023.Table 1.Figure 1.