Cardiovascular Morbidity and Mortality in COVID-19: A Multicenter Retrospective Analysis

Abstract

Background: Single-center data from COVID-19 studies suggest clinical risk factors for cardiovascular and prothrombotic complications. This study aims to identify clinical risk factors that increased the risk of pulmonary embolism (PE), myocardial infarction (MI), cerebrovascular accident (CVA), mortality, and a composite of major adverse cardiovascular events (MACE) in an urban and diverse multicenter setting. Methods: Between February and June, 2020, 4,547 patients were seen in the ER of 17 northeastern US hospitals and tested positive for COVID-19; of these, 1,171 patients were treated and released. We retrospectively analyzed the data on 3,376 patients who were admitted to these hospitals. A multivariable logistical regression analyzed patient characteristics and comorbidities in relation to said complications. Results: COVID-19 infected patients with a history of any cancer were at 2.64 times greater risk (1.519, 4.533; p=.0005) of developing PE; however, increasing age decreased the risk for PE. Patients with a history of heart failure with preserved or reduced ejection fraction (HFpEF, HFrEF) (OR=1.918; 95% CI: 1.230, 2.990; p=.0041 and OR=3.205; 95% CI: 2.272, 4.520; p<.0001), ischemic heart disease (IHD) (OR=2.429; 95% CI: 1.836, 3.215; p<.0001), end stage renal disease (ESRD) (OR=1.566 95% CI: 1.002, 2.446; p=.0489) were at higher risk for MI. Women had decreased odds of CVA compared to men (OR=0.716; 95% CI: 0.529, 0.970; p=.0308). ESRD had a positive association with CVA (OR=2.465; 95% CI: 1.545, 3.934; p=.0002). HFrEF was highly associated with MACE while women had decreased odds of MACE (OR=2.020; 95% CI: 1.453, 2.810; p<.0001). Patients with HFrEF (OR=1.623; 95% CI: 1.191, 2.211; p=.0021), chronic kidney disease (OR=1.712; 95% CI: 1.227, 2.389; p=0.0016), and diabetes (OR=1.170; 95% CI: 0.973, 1.407; p=0.0960) had an increased risk of mortality from COVID-19. Conclusion: Our analysis identified comorbidities that were strongly associated with major COVID-19 complications. Utilizing these findings may help guide clinicians with risk stratification and earlier clinical interventions. Keywords: COVID-19; Mortality; Myocardial infarction; Pulmonary embolism; Cerebrovascular accident