Subject(s)
BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Coronary Angiography/methods , Coronary Occlusion , Coronary Thrombosis , Tomography, Optical Coherence/methods , Adult , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/physiopathology , BNT162 Vaccine/administration & dosage , Chest Pain/diagnosis , Chest Pain/etiology , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/drug therapy , Coronary Occlusion/etiology , Coronary Occlusion/physiopathology , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/drug therapy , Coronary Thrombosis/etiology , Coronary Thrombosis/physiopathology , Diagnosis, Differential , Dual Anti-Platelet Therapy/methods , Electrocardiography/methods , Factor Xa Inhibitors/administration & dosage , Humans , Male , SARS-CoV-2 , Treatment Outcome , Viral Vaccines/administration & dosage , Viral Vaccines/adverse effectsABSTRACT
The occurrence of venous thromboembolisms in patients with COVID-19 has been established. We sought to evaluate the clinical impact of thrombosis in patients with COVID-19 over the span of the pandemic to date. We analyzed patients with COVID-19 with a diagnosis of thrombosis who presented to the MedStar Health system (11 hospitals in Washington, District of Columbia, and Maryland) during the pandemic (March 1, 2020, to March 31, 2021). We compared the clinical course and outcomes based on the presence or absence of thrombosis and then, specifically, the presence of cardiac thrombosis. The cohort included 11,537 patients who were admitted for COVID-19. Of these patients, 1,248 had noncardiac thrombotic events and 1,009 had cardiac thrombosis (myocardial infarction) during their hospital admission. Of the noncardiac thrombotic events, 562 (45.0%) were pulmonary embolisms, 480 (38.5%) were deep venous thromboembolisms, and 347 (27.8%) were strokes. In the thrombosis arm, the mean age of the cohort was 64.5 ± 15.3 years, 53.3% were men, and the majority were African-American (64.9%). Patients with thrombosis tended to be older with more co-morbidities. The in-hospital mortality rate was significantly higher (16.0%) in patients with COVID-19 with concomitant non-cardiac thrombosis than in those without thrombosis (7.9%, p <0.001) but lower than in patients with COVID-19 with cardiac thrombosis (24.7%, p <0.001). In conclusion, patients with COVID-19 with thrombosis, especially cardiac thrombosis, are at higher risk for in-hospital mortality. However, this prognosis is not as grim as for patients with COVID-19 and cardiac thrombosis. Efforts should be focused on early recognition, evaluation, and intensifying antithrombotic management for these patients.
Subject(s)
COVID-19/physiopathology , Coronary Thrombosis/physiopathology , Hospital Mortality , Myocardial Infarction/physiopathology , Pulmonary Embolism/physiopathology , Stroke/physiopathology , Venous Thrombosis/physiopathology , Aged , Aged, 80 and over , COVID-19/complications , Coronary Thrombosis/complications , Female , Humans , Male , Middle Aged , Myocardial Infarction/complications , Pulmonary Embolism/complications , SARS-CoV-2 , Stroke/complications , Venous Thrombosis/complicationsABSTRACT
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 has affected the health of people across the globe. Cardiovascular diseases (CVDs) have a significant relationship with COVID-19, both as a risk factor and prognostic indicator, and as a complication of the disease itself. In addition to predisposing to CVD complications, the ongoing pandemic has severely affected the delivery of timely and appropriate care for cardiovascular conditions resulting in increased mortality. The etiology behind the cardiac injury associated with severe acute respiratory syndrome coronavirus-2 is likely varied, including coronary artery disease, microvascular thrombosis, myocarditis, and stress cardiomyopathy. Further large-scale investigations are needed to better determine the underlying mechanism of myocardial infarction and other cardiac injury in COVID-19 patients and to determine the incidence of each type of cardiac injury in this patient population. Telemedicine and remote monitoring technologies can play an important role in optimizing outcomes in patients with established CVD. In this article, we summarize the various impacts that COVID-19 has on the cardiovascular system, including myocardial infarction, myocarditis, stress cardiomyopathy, thrombosis, and stroke.