• Luis Felipe Reyes, Esteban Garcia-Gallo, Srinivas Murthy, Yuli V Fuentes, Cristian C Serrano, Elsa D Ibáñez-Prada, James Lee, Amanda Rojek, Barbara Wanjiru Citarella, Bronner P Gonçalves, Jake Dunning, Indrek Rätsep, Andre Emilio Viñan-Garces, Christiana Kartsonaki, Jordi Rello, Ignacio Martin-Loeches, Manu Shankar-Hari, Piero L Olliaro, Laura Merson, and ISARIC Characterisation Group.
• Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Cundinamarca, Colombia; Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom. Electronic address: luis.reyes5@unisabana.edu.co.
• J Crit Care. 2023 Oct 1; 77: 154318154318.

PurposeTo determine its cumulative incidence, identify the risk factors associated with Major Adverse Cardiovascular Events (MACE) development, and its impact clinical outcomes.Materials And MethodsThis 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.Results49,479 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).ConclusionsPatients with severe COVID-19 frequently develop MACE, which is independently associated with worse clinical outcomes.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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