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Adjudicated Cardiovascular Events in Patients With COVID-19: Association With Vaccination Status and Changes over
Behnood Bikdeli1,2,3, Darsiya Krishnathasan1,2, Antoine Bejjani1,2
1Division of Cardiovascular Medicine, Brigham and Women's Hospital Harvard Medical School Boston MA USA.
Insights
COVID-19 patients, particularly those hospitalized or in intensive care, face significant risks of thrombotic and cardiovascular events. Vaccination against COVID-19 was found to reduce the risk of these cardiovascular complications.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Patients with COVID-19 are susceptible to thrombotic and cardiovascular complications.
- Previous risk estimates may not reflect current event rates or vaccination impacts.
- Understanding contemporary trends and vaccination effects is crucial for patient management.
Purpose of the Study:
- To assess recent rates of thrombotic and cardiovascular events in COVID-19 patients.
- To analyze temporal trends in these events over time.
- To determine the association between COVID-19 vaccination status and cardiovascular outcomes.
Main Methods:
- Utilized the CORONA-VTE Network multicenter registry (March 2020-February 2024).
- Assessed composite outcomes of thrombotic and cardiovascular events at 90 days post-COVID-19 diagnosis.
- Conducted time-to-event analyses stratified by inpatient/outpatient status, adjusting for competing risks.
Main Results:
- Among 11,165 patients, 4,451 were inpatients with 90-day incidences of 8.9% for thrombotic and 15.6% for cardiovascular events.
- Intensive care unit patients had higher event rates (20.0% thrombotic, 30.7% cardiovascular).
- COVID-19 vaccination was associated with a reduced risk of cardiovascular events (adjusted HR, 0.75; P=0.005).
Conclusions:
- Thrombotic and cardiovascular events remain common in hospitalized COVID-19 patients, especially in the ICU.
- No persistent decline in cardiovascular events was observed over the study period.
- COVID-19 vaccination demonstrated a protective association against cardiovascular events.
Background:
Patients with COVID-19 are at risk of thrombotic and cardiovascular complications. Existing risk estimates derive from early COVID-19 experiences. More recent event rates, temporal trends, and the association between vaccination status and cardiovascular outcomes remain unclear.
Methods:
The CORONA-VTE Network (COVID-19 Registry to Assess Frequency, Risk Factors, Management, and Outcomes of Arterial and Venous Thromboembolic Complications) multicenter registry included patients with COVID-19 from March 2020 to February 2024. A composite of venous and arterial thrombotic events and a composite of adjudicated cardiovascular events were assessed at 90 days after COVID-19 diagnosis. Time-to-first-event analyses were stratified by inpatients and outpatients and adjusted for competing risks. Outcomes were adjudicated by independent physicians.
Results:
Of 11 165 patients, 4451 were inpatients (mean age, 65 years; 47% women) and 462 of 4451 were admitted to the intensive care unit. Among inpatients, the 90-day cumulative incidences of thrombotic and cardiovascular events were 8.9% (95% CI, 8.0%-9.8%) and 15.6% (95% CI, 14.5%-16.7%), respectively. Corresponding estimates for patients in the intensive care unit were 20.0% (95% CI, 16.6%-24.0%) and 30.7% (95% CI, 26.8%-35.3%), while event rates were low among outpatients. There was an initial decline in cardiovascular events (adjusted hazard ratio [HR], 0.84; P=0.001) after the first COVID-19 wave, with a subsequent catch-up, with no significant linear change in cardiovascular events (adjusted Ptrend=0.634). Vaccination was associated with a reduced risk of cardiovascular events (adjusted HR, 0.75 [95% CI, 0.62-0.92]; P=0.005).
Conclusions:
Thrombotic and cardiovascular events are common in hospitalized patients with COVID-19, especially those in the intensive care unit, without a persistent decline over time. COVID-19 vaccination was associated with a reduced risk of cardiovascular events.
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