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Ortega-Paz L, Arévalos V, Fernández-Rodríguez D, Jiménez-Díaz V, Bañeras J, Campo G, Rodríguez-Santamarta M, Díaz JF, Scardino C, Gómez-Álvarez Z, Pernigotti A, Alfonso F, Amat-Santos IJ, Silvestro A, Rampa L, de la Torre Hernández JM, Bastidas G, Gómez-Lara J, Bikdeli B, García-García HM, Angiolillo DJ, Rodés-Cabau J, Sabaté M, Brugaletta S. One-year cardiovascular outcomes after coronavirus disease 2019: The cardiovascular COVID-19 registry. PLoS One 2022; 17:e0279333. [PMID: 36583998 PMCID: PMC9803130 DOI: 10.1371/journal.pone.0279333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The long-term cardiovascular (CV) outcomes of COVID-19 have not been fully explored. METHODS This was an international, multicenter, retrospective cohort study conducted between February and December 2020. Consecutive patients ≥18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 were included. Patients were classified into two cohorts depending on the nasopharyngeal swab result and clinical status: confirmed COVID-19 (positive RT-PCR) and control (without suggestive symptoms and negative RT-PCR). Data were obtained from electronic records, and clinical follow-up was performed at 1-year. The primary outcome was CV death at 1-year. Secondary outcomes included arterial thrombotic events (ATE), venous thromboembolism (VTE), and serious cardiac arrhythmias. An independent clinical event committee adjudicated events. A Cox proportional hazards model adjusted for all baseline characteristics was used for comparing outcomes between groups. A prespecified landmark analysis was performed to assess events during the post-acute phase (31-365 days). RESULTS A total of 4,427 patients were included: 3,578 (80.8%) in the COVID-19 and 849 (19.2%) control cohorts. At one year, there were no significant differences in the primary endpoint of CV death between the COVID-19 and control cohorts (1.4% vs. 0.8%; HRadj 1.28 [0.56-2.91]; p = 0.555), but there was a higher risk of all-cause death (17.8% vs. 4.0%; HRadj 2.82 [1.99-4.0]; p = 0.001). COVID-19 cohort had higher rates of ATE (2.5% vs. 0.8%, HRadj 2.26 [1.02-4.99]; p = 0.044), VTE (3.7% vs. 0.4%, HRadj 9.33 [2.93-29.70]; p = 0.001), and serious cardiac arrhythmias (2.5% vs. 0.6%, HRadj 3.37 [1.35-8.46]; p = 0.010). During the post-acute phase, there were no significant differences in CV death (0.6% vs. 0.7%; HRadj 0.67 [0.25-1.80]; p = 0.425), but there was a higher risk of deep vein thrombosis (0.6% vs. 0.0%; p = 0.028). Re-hospitalization rate was lower in the COVID-19 cohort compared to the control cohort (13.9% vs. 20.6%; p = 0.001). CONCLUSIONS At 1-year, patients with COVID-19 experienced an increased risk of all-cause death and adverse CV events, including ATE, VTE, and serious cardiac arrhythmias, but not CV death. STUDY REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT04359927.
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Affiliation(s)
- Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States of America
| | - Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
| | | | | | - Jordi Bañeras
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Gianluca Campo
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | | | | | - Claudia Scardino
- Department of Cardiology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | | | - Alberto Pernigotti
- Department of Cardiology, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa, Madrid, Spain
| | - Ignacio J. Amat-Santos
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Antonio Silvestro
- Department of Cardiology, Azienda Ospedaliera Bolognini Seriate, Bérgamo, Italy
| | - Lorenzo Rampa
- Department of Cardiology, Clinical Institute Saint Ambrogio, Milano, Italy
| | | | - Gabriela Bastidas
- Department of Cardiology, Hospital Universitario Sagrat Cor, Barcelona, Spain
| | - Josep Gómez-Lara
- Department of Cardiology, Hospital de Bellvitge, Barcelona, Spain
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, United States of America
- Cardiovascular Research Foundation (CRF), New York, New York, United States of America
| | - Hector M. García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States of America
| | - Josep Rodés-Cabau
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Universitari Clinic, Barcelona, Spain
- * E-mail:
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Playán-Escribano J, Gómez-Álvarez Z, Romero-Delgado T, Pérez-García CN, Enríquez-Vázquez D, Vilacosta I. Cardiovascular comorbidity and death from COVID-19: Prevalence and differential characteristics. Cardiol J 2021; 28:339-341. [PMID: 33634840 DOI: 10.5603/cj.a2021.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Isidre Vilacosta
- Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain
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Pérez-García CN, Enríquez-Vázquez D, Méndez-Bailón M, Olmos C, Gómez-Polo JC, Iguarán R, Ramos-López N, García-Klepzig JL, Ferrández-Escarabajal M, Jerónimo A, Martínez-Gómez E, Font-Urgelles J, Fragiel-Saavedra M, Paz-Arias P, Romero-Delgado T, Gómez-Álvarez Z, Playán-Escribano J, Jaén E, Vargas G, González E, Orviz E, Burruezo I, Calvo A, Nieto Á, Molino Á, Lorenzo-Villalba N, Andrès E, Macaya C, Vilacosta I. The SADDEN DEATH Study: Results from a Pilot Study in Non-ICU COVID-19 Spanish Patients. J Clin Med 2021; 10:jcm10040825. [PMID: 33670462 PMCID: PMC7922313 DOI: 10.3390/jcm10040825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. Methods: In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. Results: In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. Conclusions: This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.
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Affiliation(s)
- Carlos Nicolás Pérez-García
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
- Correspondence: ; Tel.: +34-913302712; Fax: +34-913303290
| | - Daniel Enríquez-Vázquez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Manuel Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Juan Carlos Gómez-Polo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Rosario Iguarán
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Noemí Ramos-López
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - José Luis García-Klepzig
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Marcos Ferrández-Escarabajal
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Eduardo Martínez-Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | | | - Marcos Fragiel-Saavedra
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Pilar Paz-Arias
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Teresa Romero-Delgado
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Zaira Gómez-Álvarez
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Julia Playán-Escribano
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Esther Jaén
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Gianna Vargas
- Servicio de Neumología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (G.V.); (E.G.)
| | - Elizabeth González
- Servicio de Neumología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (G.V.); (E.G.)
| | - Eva Orviz
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Irene Burruezo
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Alberto Calvo
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Ángel Nieto
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Ángel Molino
- Servicio de Medicina Interna, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.M.-B.); (N.R.-L.); (J.L.G.-K.); (M.F.-S.); (P.P.-A.); (E.J.); (E.O.); (I.B.); (A.C.); (Á.N.); (Á.M.)
| | - Noël Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (N.L.-V.); (E.A.)
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; (N.L.-V.); (E.A.)
| | - Carlos Macaya
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (D.E.-V.); (C.O.); (J.C.G.-P.); (R.I.); (M.F.-E.); (A.J.); (E.M.-G.); (T.R.-D.); (Z.G.-Á.); (J.P.-E.); (C.M.); (I.V.)
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