Anticoagulation Use as an Independent Predictor of Mortality and Major Adverse Cardiovascular Events in Hospitalized COVID-19 Patients: A Multicenter Retrospective Analysis.

Background: Coronavirus disease 2019 (COVID-19) is associated with increased incidence of cardiac arrhythmias and thrombotic events. The adverse cardiovascular outcomes related to ambulatory anticoagulation (AC) therapy in COVID-19 patients are unknown. The goal of this study was to identify the effects of AC use in hospitalized COVID-19 patients. Methods: This is a multicenter, retrospective study that identified 2,801 hospitalized COVID-19 polymerase chain reaction (PCR)-positive patients admitted between March 2020 and July 2021. Of these, 375 (13.4%) were ambulatory AC users. Data were collected from the electronic health records of hospitalized patients. Mortality included in-hospital death and hospice referral. Major adverse cardiovascular events (MACEs) included acute heart failure (HF), myocardial infarction (MI), myocarditis, pulmonary embolism (PE), deep venous thrombosis (DVT), pericardial effusion, pericarditis, stroke, shock, and cardiac tamponade. A Chi-square test was used to analyze categorical variables, and multivariate logistic regression analysis was performed to account for comorbidities. Results: AC non-users exhibited a higher incidence of mortality than AC users (13.9% vs. 7.7%, P = 0.001). However, MACE incidence was higher in AC users than AC non-users (44.8% vs. 26.8%, P < 0.001). The higher MACE incidence was driven by higher rates of acute HF (8.3% vs. 2.5%, P < 0.001), MI (26.9% vs. 18.2%, P < 0.001), PE/DVT (16.3% vs. 2.7%, P < 0.001), pericardial effusion (1.6% vs. 0.5%, P = 0.025), and stroke (2.9% vs. 1.2%, P = 0.018). After multivariate logistic regression, MACE incidence remained higher (odds ratio (OR) = 1.61, 95% confidence interval (CI): 1.27 - 2.05, P < 0.001) and all-cause mortality rate lower (OR = 0.34, 95% CI: 0.23 - 0.52, P < 0.001) in AC users. Conclusions: Ambulatory AC use is associated with increased MACEs but decreased all-cause mortality in patients hospitalized with COVID-19. This study will help physicians identify patients at risk of cardiovascular mortality and direct management based on the identified risk.

Coronary Artery Disease as an Independent Predictor of Cardiovascular Mortality in COVID-19 Patients.

Background: Coronavirus disease 2019 (COVID-19) is associated with increased risk of cardiovascular mortality. However, little is known about the combined effect of coronary artery disease (CAD) and COVID-19 on mortality. We aimed to investigate the incidence of cardiovascular and all-cause mortality in COVID-19 patients with CAD. Methods: This multicenter retrospective study identified 3,336 COVID-19 patients admitted between March and December 2020. Data points were manually reviewed in the patients' electronic health records. Multivariate logistic regression was used to assess whether CAD and its subtypes were associated with mortality. Results: This study shows that CAD was not an independent predictor of all-cause mortality (odds ratio (OR): 1.512, 95% confidence interval (CI): 0.1529 - 14.95, P = 0.723). However, there was a significant increase in cardiovascular mortality in patients with CAD compared to those without (OR: 6.89, 95% CI: 2.706 - 17.53, P < 0.001). There was no significant difference in all-cause mortality in patients with left main artery and left anterior descending artery disease (OR: 1.29, 95% CI: 0.80 - 2.08, P = 0.29). However, CAD patients with a history of interventions (e.g., coronary stenting or coronary artery bypass graft) showed increased mortality compared to those solely treated by medical management (OR: 1.93, 95% CI: 1.12 - 3.33, P = 0.017). Conclusions: CAD is associated with a higher incidence of cardiovascular mortality but not all-cause mortality in COVID-19 patients. Overall, this study will help clinicians identify characteristics of COVID-19 patients with increased risk of mortality in the setting of CAD.

Mortality and Major Adverse Cardiovascular Events in Hospitalized Patients With Atrial Fibrillation With COVID-19.

COVID-19 results in increased incidence of cardiac arrhythmias, including atrial fibrillation (AF). However, little is known about the combined effect of AF and COVID-19 on patient outcomes. This study aimed to determine if AF, specifically new-onset AF (NOAF), is associated with increased risk of mortality and major adverse cardiovascular events (MACEs) in hospitalized patients with COVID-19. This multicenter retrospective analysis identified 2,732 patients with COVID-19 admitted between March and December 2020. Data points were manually reviewed in the patients' electronic health records. Multivariate logistic regression was used to assess if AF was associated with death or MACE. Patients with AF (6.4%) had an increased risk of mortality (risk ratio 2.249, 95% confidence interval [CI] 1.766 to 2.864, p <0.001) and MACE (risk ratio 1.753, 95% CI 1.473 to 2.085, p <0.001) compared with those with sinus rhythm. Patients with NOAF had an increased risk of mortality compared with those with existing AF (odds ratio 19.30, 95% CI 5.39 to 69.30, p <0.001); the risk of MACE was comparable between NOAF and patients with existing AF (p = 1). AF during hospitalization with COVID-19 is associated with a higher risk of mortality and MACE. NOAF in patients with COVID-19 is associated with a higher risk of mortality but a similar risk of MACE compared with patients with existing AF.

A Real Headache: Intracranial Extension and Epidural Abscess As Complication of Chronic Mucocele.

Mucoceles are benign lesions of salivary glands typically originating from the paranasal sinuses. Intracranial extension and superinfection of these lesions are rare but serious complications of chronic mucoceles. Here, we discuss a patient with a known mucocele, initially lost to follow-up, who presented three years later with headache, purulent rhinorrhea, and intracranial extension of his mucocele with development of an epidural abscess. This case highlights the potential complications of chronic, large mucoceles and emphasizes the importance of thorough evaluation in patients with facial abscesses in the setting of known sinus pathology. Any mucocele with signs of superinfection such as purulent rhinorrhea, abscess near the sinuses, or refractory symptoms should warrant cranial imaging. Mucoceles with evidence of intracranial extension require neurosurgical and/or otolaryngologic evaluation for evacuation and debridement to avoid neurologic injury or devastating infection.

Dressler Syndrome: Not Just a Relic of the Past.

Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. It is characterized by pericardial inflammation typically including pericardial effusion, pleuritic chest pain, and elevated inflammatory markers. While its incidence has greatly decreased in the modern era of coronary revascularization, it remains a clinically important entity with the potential for serious morbidity. Here we present a case of presumed Dressler syndrome in a 54-year-old male who presented to the emergency room with a recurrence of chest pain and clinical signs of pericarditis after sustaining an anterior myocardial infarction two weeks previously.