tetano
Editor, Senior Moderator
J Clin Med
. 2021 Sep 2;10(17):3982.
doi: 10.3390/jcm10173982.
Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients-Results from the CORONA Germany Study
Melanie A Gunawardene[SUP] 1 [/SUP], Nele Gessler[SUP] 1 2 3 [/SUP], Peter Wohlmuth[SUP] 2 [/SUP], Kathrin Heitmann[SUP] 2 [/SUP], Philipp Anders[SUP] 3 [/SUP], Kai Jaquet[SUP] 2 [/SUP], Christoph U Herborn[SUP] 2 3 4 [/SUP], Dirk Arnold[SUP] 5 [/SUP], Berthold Bein[SUP] 6 [/SUP], Martin W Bergmann[SUP] 7 [/SUP], Klaus R Herrlinger[SUP] 8 [/SUP], Axel Stang[SUP] 3 9 [/SUP], Ruediger Schreiber[SUP] 10 [/SUP], Claas Wesseler[SUP] 11 [/SUP], Stephan Willems[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Acute myocardial injury (AMJ), assessed by elevated levels of cardiac troponin, is associated with fatal outcome in coronavirus disease 2019 (COVID-19). However, the role of acute cardiovascular (CV) events defined by clinical manifestation rather than sole elevations of biomarkers is unclear in hospitalized COVID-19 patients.
Objective: The aim of this study was to investigate acute clinically manifest CV events in hospitalized COVID-19 patients.
Methods: From 1 March 2020 to 5 January 2021, we conducted a multicenter, prospective, epidemiological cohort study at six hospitals from Hamburg, Germany (a portion of the state-wide 45-center CORONA Germany cohort study) enrolling all hospitalized COVID-19 patients. Primary endpoint was occurrence of a clinically manifest CV-event.
Results: In total, 132 CV-events occurred in 92 of 414 (22.2%) patients in the Hamburg-cohort: cardiogenic shock in 10 (2.4%), cardiopulmonary resuscitation in 12 (2.9%), acute coronary syndrome in 11 (2.7%), de-novo arrhythmia in 31 (7.5%), acute heart-failure in 43 (10.3%), myocarditis in 2 (0.5%), pulmonary-embolism in 11 (2.7%), thrombosis in 9 (2.2%) and stroke in 3 (0.7%). In the Hamburg-cohort, mortality was 46% (42/92) for patients with a CV-event and 33% (27/83) for patients with only AMJ without CV-event (OR 1.7, CI: (0.94-3.2), p = 0.077). Mortality was higher in patients with CV-events (Odds ratio(OR): 4.8, 95%-confidence-interval(CI): [2.9-8]). Age (OR 1.1, CI: (0.66-1.86)), atrial fibrillation (AF) on baseline-ECG (OR 3.4, CI: (1.74-6.8)), systolic blood-pressure (OR 0.7, CI: (0.53-0.96)), potassium (OR 1.3, CI: (0.99-1.73)) and C-reactive-protein (1.4, CI (1.04-1.76)) were associated with CV-events.
Conclusion: Hospitalized COVID-19 patients with clinical manifestation of acute cardiovascular events show an almost five-fold increased mortality. In this regard, the emergence of arrhythmias is a major determinant.
Keywords: COVID-19; atrial fibrillation; cardiovascular disease; coronavirus; troponin.
. 2021 Sep 2;10(17):3982.
doi: 10.3390/jcm10173982.
Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients-Results from the CORONA Germany Study
Melanie A Gunawardene[SUP] 1 [/SUP], Nele Gessler[SUP] 1 2 3 [/SUP], Peter Wohlmuth[SUP] 2 [/SUP], Kathrin Heitmann[SUP] 2 [/SUP], Philipp Anders[SUP] 3 [/SUP], Kai Jaquet[SUP] 2 [/SUP], Christoph U Herborn[SUP] 2 3 4 [/SUP], Dirk Arnold[SUP] 5 [/SUP], Berthold Bein[SUP] 6 [/SUP], Martin W Bergmann[SUP] 7 [/SUP], Klaus R Herrlinger[SUP] 8 [/SUP], Axel Stang[SUP] 3 9 [/SUP], Ruediger Schreiber[SUP] 10 [/SUP], Claas Wesseler[SUP] 11 [/SUP], Stephan Willems[SUP] 1 [/SUP]
Affiliations
- PMID: 34501427
- DOI: 10.3390/jcm10173982
Abstract
Background: Acute myocardial injury (AMJ), assessed by elevated levels of cardiac troponin, is associated with fatal outcome in coronavirus disease 2019 (COVID-19). However, the role of acute cardiovascular (CV) events defined by clinical manifestation rather than sole elevations of biomarkers is unclear in hospitalized COVID-19 patients.
Objective: The aim of this study was to investigate acute clinically manifest CV events in hospitalized COVID-19 patients.
Methods: From 1 March 2020 to 5 January 2021, we conducted a multicenter, prospective, epidemiological cohort study at six hospitals from Hamburg, Germany (a portion of the state-wide 45-center CORONA Germany cohort study) enrolling all hospitalized COVID-19 patients. Primary endpoint was occurrence of a clinically manifest CV-event.
Results: In total, 132 CV-events occurred in 92 of 414 (22.2%) patients in the Hamburg-cohort: cardiogenic shock in 10 (2.4%), cardiopulmonary resuscitation in 12 (2.9%), acute coronary syndrome in 11 (2.7%), de-novo arrhythmia in 31 (7.5%), acute heart-failure in 43 (10.3%), myocarditis in 2 (0.5%), pulmonary-embolism in 11 (2.7%), thrombosis in 9 (2.2%) and stroke in 3 (0.7%). In the Hamburg-cohort, mortality was 46% (42/92) for patients with a CV-event and 33% (27/83) for patients with only AMJ without CV-event (OR 1.7, CI: (0.94-3.2), p = 0.077). Mortality was higher in patients with CV-events (Odds ratio(OR): 4.8, 95%-confidence-interval(CI): [2.9-8]). Age (OR 1.1, CI: (0.66-1.86)), atrial fibrillation (AF) on baseline-ECG (OR 3.4, CI: (1.74-6.8)), systolic blood-pressure (OR 0.7, CI: (0.53-0.96)), potassium (OR 1.3, CI: (0.99-1.73)) and C-reactive-protein (1.4, CI (1.04-1.76)) were associated with CV-events.
Conclusion: Hospitalized COVID-19 patients with clinical manifestation of acute cardiovascular events show an almost five-fold increased mortality. In this regard, the emergence of arrhythmias is a major determinant.
Keywords: COVID-19; atrial fibrillation; cardiovascular disease; coronavirus; troponin.