Major adverse cardiovascular events (MACE) in patients with severe COVID-19 registered in the ISARIC WHO clinical characterization protocol: A prospective, multinational, observational study.
Journal
Journal of critical care
Series/Report No.
Journal of Critical Care
Journal Volume
77
Start Page
154318
ISSN
1557-8615
Date Issued
2023-10
Author(s)
Reyes, Luis Felipe
Garcia-Gallo, Esteban
Murthy, Srinivas
Fuentes, Yuli V
Serrano, Cristian C
et al.
DOI
10.1016/j.jcrc.2023.154318
Abstract
Purpose: To determine its cumulative incidence, identify the risk factors associated with Major Adverse Cardiovascular Events (MACE) development, and its impact clinical outcomes.
Materials and methods: This multinational, multicentre, prospective cohort study from the ISARIC database. We used bivariate and multivariate logistic regressions to explore the risk factors related to MACE development and determine its impact on 28-day and 90-day mortality.
Results: 49,479 patients were included. Most were male 63.5% (31,441/49,479) and from high-income countries (84.4% [42,774/49,479]); however, >6000 patients were registered in low-and-middle-income countries. MACE cumulative incidence during their hospital stay was 17.8% (8829/49,479). The main risk factors independently associated with the development of MACE were older age, chronic kidney disease or cardiovascular disease, smoking history, and requirement of vasopressors or invasive mechanical ventilation at admission. The overall 28-day and 90-day mortality were higher among patients who developed MACE than those who did not (63.1% [5573/8829] vs. 35.6% [14,487/40,650] p < 0.001; 69.9% [6169/8829] vs. 37.8% [15,372/40,650] p < 0.001, respectively). After adjusting for confounders, MACE remained independently associated with higher 28-day and 90-day mortality (Odds Ratio [95% CI], 1.36 [1.33-1.39];1.47 [1.43-1.50], respectively).
Conclusions: Patients with severe COVID-19 frequently develop MACE, which is independently associated with worse clinical outcomes.
Trial registration: ClinicalTrials.gov NCT04262921.
Subjects
COVID-19
Complications
Major adverse cardiovascular events (MACE)
Mortality
Publisher
Elsevier BV
Type
journal article