Nationwide Database Study Describes Intracardiac Thrombosis in Patients with COVID-19

Intracardiac thrombosis in patients with COVID-19 was independently associated with increased all-cause and cardiovascular mortality and in-hospital cardiac arrest, acute coronary syndrome (ACS), stroke, and acute kidney injury (AKI) despite a low incidence rate, according to a National Inpatient Sample database analysis, published in Angiology.

Key predictive factors included male sex, non-Caucasian ethnicities (especially Native Americans), heart failure, prior stroke, and coagulopathy.

“The presence of several of these factors should alert clinicians to a higher suspicion for intracardiac thrombosis if there are concerning clinical symptoms or deterioration in COVID-19 inpatients,” suggested the study’s authors, led by Ankit Agrawal, MD, from the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic in Ohio.

The analysis reviewed 1,638,785 inpatients with COVID-19 in 2020 who had a mean age of 63.8 years and were 32.2% female. Overall, the incidence of intracardiac thrombosis was 0.10% (n=1,830). Subsequent in-hospital outcomes for these cases included all-cause mortality in 13.2%, cardiovascular mortality in 3.5%, cardiac arrest in 2.6%, ACS in 4.4%, heart failure in 16.1%, stroke in 1.3%, and AKI in 28.3%.

Via multivariable logistic regression analyses, researchers estimated odds ratios (ORs) associated with intracardiac thrombosis for the following events.

• All-cause mortality, 3.32 (95% CI, 2.42-4.54)
• Cardiovascular mortality, 2.95 (95% CI, 1.96-4.44)
• Cardiac arrest, 2.04 (95% CI, 1.22-3.43)
• ACS, 1.62 (95% CI, 1.17-2.22)
• Stroke, 3.10 (95% CI, 2.11-4.56)
• AKI, 2.13 (95% CI, 1.68-2.69)

The authors noted that intracardiac thrombosis was not independently linked to increased risk of heart failure.

In short, intracardiac thrombosis was rare, but did independently increase risks of mortality and morbidity among patients with COVID-19.

Reference

Agrawal A, Bajaj S, Bhagat U, et al. Intracardiac thrombus in COVID-19 Inpatients: a nationwide study of incidence, predictors, and outcomes. Angiology. 2024. doi:10.1177/00033197231225282