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.
Keywords: COVID‐19; cardiovascular; thrombosis; vaccine.