Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Cardiol


Background: Endothelial cell dysfunction from infection by SARS-CoV-2 and inflammatory cytokines leading to hyperinflammatory and hypercoagulable state is thought to be the mechanism of arterial thromboembolism (ATE) in COVID-19 patients. COVID-19 infection is known to be an independent risk factor for acute stroke and myocardial infarction (MI). However, data on the risk factors of ATE in hospitalized COVID-19 patients is limited.

Methods: This retrospective, multicenter cohort study included adult patients admitted to one quaternary care and three community hospitals with PCR-proven SARS-CoV-2 infection between 3/1/2020 and 12/31/2020. The composite outcome was in-hospital ATE events, including acute ischemic stroke, MI, and other ATE identified by ICD-10 codes. Student t-test was conducted for continuous variables and the Chi-square test for categorical variables. Multivariate logistic regression using forward selection was conducted. All statistical tests were 2-sided with an α level of 0.05. All data was analyzed using R version 4.0.4.

Results: The cohort included 3531 patients with 371 (10.5%) patients who developed acute ATE. There were 398 ATE events: 270 patients had MI, 43 had stroke, 85 had other ATE, 12 had MI + stroke, 13 had MI + other ATE, and 2 had stroke + other ATE. The model suggested that initial systolic blood pressure (BP) <90 mmHg and >160 mmHg; elevated initial biomarkers including B-type natriuretic peptide (>100 pg/mL), troponin-I (>0.03 ng/mL), lactate dehydrogenase (>192 U/L), creatine phosphokinase (male >280 U/L and female >155 U/L), C-reactive protein (>0.5 mg/dL), leukocytes (>11 K/uL), lactate (>2.2 mmol/L), and aspartate aminotransferase (>41 U/L); presenting hypoalbuminemia (<3.5 g/dL) and hypomagnesemia (<1.8 mg/dL); age >60; male sex; and history of cerebrovascular accident (CVA), coronary artery disease (CAD), hyperthyroidism, and cigarette smoking were associated with an increased risk of ATE (all p<0.05).

Conclusion: Hypo or hypertension on admission, elevated inflammatory and cardiac markers, hypoalbuminemia, hypomagnesemia, smoking, and comorbidities including CAD and CVA are associated with ATE in hospitalized COVID-19 patients.





First Page




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.