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. 2021 Dec;35(12):3581-3593.
doi: 10.1053/j.jvca.2021.03.035. Epub 2021 Mar 27.

Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients

Qian Xu  1 , Harideep Samanapally  2 , Pavani Nathala  2 , Vidyulata Salunkhe  2 , Stephen Furmanek  2 , Meredith N Cahill  3 , Trevor McGuffin  4 , Tahboub Mohammad  2 , Bradford Marsili  5 , Jessica Petrey  6 , Ruth Carrico  2 , Julio Ramirez  2 , Ozan Akca  5 , Sean P Clifford  5 , Siddharth Pahwa  7 , Lynn Roser  4 , Maiying Kong  1 , Jiapeng Huang  8 ; Center of Excellence for Research in Infectious Diseases (CERID) Coronavirus Study Group on behalf of the COVID-19 CardioVascular Research Group (COVID-CVRG)
Affiliations

Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients

Qian Xu et al. J Cardiothorac Vasc Anesth. 2021 Dec.

Abstract

Objective: To analyze outcomes and risk factors of cardiovascular events in a metropolitan coronavirus disease 2019 (COVID-19) database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race.

Design: Retrospective cohort analysis from March 9, 2020 to June 20, 2020.

Setting: Population-based study in Louisville, KY, USA.

Participants: Seven hundred adult inpatients hospitalized with COVID-19.

Interventions: N/A.

Measurements and main results: This cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% v 8.7%, p < 0.001). There was no difference between African American and white patients regarding mortality (43.9% v 46.3%, p = 1) and length of stay for survivors (11 days v 9.5 days, p = 0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FIO2, higher serum potassium, lower serum albumin, and number of cardiovascular comorbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic and/or immune-compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FIO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients.

Conclusions: Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.

Keywords: COVID-19; SARS-CoV-2; cardiovascular; coronavirus; outcome; risk factors.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig 1
Fig 1
(A) Kaplan-Meier survival probability estimates for hospitalized COVID-19 patients stratified with or without cardiovascular events for entire cohort. (B) African Americans patients. (C) White patients.
Fig 2
Fig 2
Summary of similar and different risk factors in African American and white COVID-19 patients. WBC, White Blood Cell count; AST, aspartate aminotransferase; CV, cardiovascular; N/L ratio, Neutrophil-Lymphocyte ratio; D-Dimer, D-domain-dimer (D-dimer); BNP, B-type natriuretic peptide; ProBNP, N-terminal pro b-type natriuretic peptide; IL-6, interleukin-6; CRP, C-reactive protein; ALT, alanine aminotransferase.
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