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

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 high-risk 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.
Competing Interests: A.C.S. has consulting for Janssen, Boehringer Ingelheim, Bayer, Bristol-Myers Squibb, Portola, and ATLAS Group and received research funding from Janssen and Boehringer Ingelheim. M.G. receives research grant support and honoraria from Janssen. M.M. has consulted for Bayer and Pfizer and received support for congress attendance from Bayer, Pfizer, and Leo. E.A. has consulted for Bayer and received support for congress attendance from Bayer and Boehringer Ingelheim. The remaining authors have nothing to disclose.
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