Adjudicated Cardiovascular Events in Patients With COVID-19: Association With Vaccination Status and Changes over Time.

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.