Relation of Cardiovascular Risk Factors to Mortality and Cardiovascular Events in Hospitalized Patients with Coronavirus Disease 2019 (From the Yale COVID-19 Cardiovascular Registry)

Pareek, Manan; Singh, Avinainder; Vadlamani, Lina; Eder, Maxwell; Pacor, Justin; Park, Jakob; Ghazizadeh, Zaniar; Heard, Alex; Cruz-Solbes, Ana Sofia; Nikooie, Roozbeh; Gier, Chad; Ahmed, Zain V.; Freeman, James V.; Meadows, Judith; Smolderen, Kim G.E.; Lampert, Rachel; Velazquez, Eric J.; Ahmad, Tariq; Desai, Nihar R.

Individuals with established cardiovascular disease or a high burden of cardiovascular risk factors may be particularly vulnerable to develop complications from coronavirus disease 2019 (COVID-19). We conducted a prospective cohort study at a tertiary care center to identify risk factors for in-hospital mortality and major adverse cardiovascular events (MACE; a composite of myocardial infarction, stroke, new acute decompensated heart failure, venous thromboembolism, ventricular or atrial arrhythmia, pericardial effusion, or aborted cardiac arrest) among consecutively hospitalized adults with COVID-19, using multivariable binary logistic regression analysis. The study population comprised 586 COVID-19 positive patients. Median age was 67 (IQR: 55-80) years, 47.4% were female, and 36.7% had cardiovascular disease. Considering risk factors, 60.2% had hypertension, 39.8% diabetes, and 38.6% hyperlipidemia. Eighty-two individuals (14.0%) died in-hospital, and 135 (23.0%) experienced MACE. In a model adjusted for demographic characteristics, clinical presentation, and laboratory findings, age (odds ratio [OR], 1.28 per 5 years; 95% confidence interval [CI], 1.13-1.45), prior ventricular arrhythmia (OR, 18.97; 95% CI, 3.68-97.88), use of P2Y(12)-inhibitors (OR, 7.91; 95% CI, 1.64-38.17), higher C-reactive protein (OR, 1.81: 95% CI, 1.18-2.78), lower albumin (OR, 0.64: 95% CI, 0.47-0.86), and higher troponin T (OR, 1.84; 95% CI, 1.39-2.46) were associated with mortality (p<0.05). After adjustment for demographics, presentation, and laboratory findings, predictors of MACE were higher respiratory rates, altered mental status, and laboratory abnormalities, including higher troponin T (p<0.05). In conclusion, poor prognostic markers among hospitalized patients with COVID-19 included older age, pre-existing cardiovascular disease, respiratory failure, altered mental status, and higher troponin T concentrations.