Risk Factors for Postdischarge Major Thromboembolism and Mortality in Hospitalized Patients with COVID-19 with Cardiovascular Comorbidities: Insights from the CORE-19 Registry

Abstract

Background Coronavirus disease 2019 (COVID-19) is associated with venous and arterial thromboembolism (VTE and ATE) and all-cause mortality (ACM) in hospitalized patients. High-quality data are needed on postdischarge outcomes in patients with cardiovascular disease. Objectives To analyze outcomes and identify risk factors for ATE, VTE, and ACM in a highrisk subgroup of hospitalized COVID-19 patients with baseline cardiovascular disease. Methods We investigated postdischarge rates and associated risk factors of ATE, VTE, and ACM in 608 hospitalized COVID-19 patients with coronary artery disease, carotid artery stenosis (CAS), peripheral arterial disease (PAD), or ischemic stroke. Results Through 90 days postdischarge, outcome rates were: ATE 27.3% (10.2% myocardial infarction, 10.1% ischemic stroke, 13.2% systemic embolism, 12.7% major adverse limb event); VTE 6.9% (4.1% deep vein thrombosis, 3.6% pulmonary embolism); composite of ATE, VTE, or ACM 35.2% (214/608). Multivariate analysis showed significant association between this composite endpoint and age 75 years (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.22-2.94, p- 0.004), PAD (OR: 3.23, 95% CI: 1.80-5.81, p 0.0001), CAS (OR: 1.74, 95% CI: 1.11-2.75, p- 0.017), congestive heart failure (CHF) (OR: 1.84, 95% CI: 1.02-3.35, p- 0.044), previous VTE (OR: 3.08, 95% CI: 1.75-5.42, p 0.0001), and intensive care unit (ICU) admission (OR: 2.93, 95% CI: 1.81-4.75, p 0.0001). Conclusion COVID-19 inpatients with cardiovascular disease experience high rates of ATE, VTE, or ACM through 90 days postdischarge. Age 75 years, PAD, CAS, CHF, previous VTE, and ICU admission are independent risk factors.