The ISARIC Characterisation Group2026-01-192026-01-192023-10The ISARIC Characterisation Group 2023, 'Major adverse cardiovascular events (MACE) in patients with severe COVID-19 registered in the ISARIC WHO clinical characterization protocol : A prospective, multinational, observational study', Journal of Critical Care, vol. 77, 154318. https://doi.org/10.1016/j.jcrc.2023.1543180883-9441PubMedCentral: PMC10167415https://hdl.handle.net/10641/7409Publisher Copyright: © 2023 The AuthorsObjetivo: Determinar su incidencia acumulada, identificar los factores de riesgo asociados al desarrollo de eventos cardiovasculares adversos mayores (MACE) y su repercusión en los resultados clínicos. Materiales y métodos: Estudio de cohortes prospectivo, multinacional y multicéntrico a partir de la base de datos ISARIC. Empleamos regresiones logísticas bivariantes y multivariantes para explorar los factores de riesgo relacionados con el desarrollo de MACE y determinar su repercusión en la mortalidad a 28 y a 90 días. Resultados: Se incluyeron 49.479 pacientes. La mayoría eran varones, un 63,5 % (31.441/49.479), y procedían de países de ingresos altos (84,4 % [42.774/49.479]); no obstante, se registraron >6000 pacientes en países de ingresos bajos y medios. La incidencia acumulada de MACE durante la estancia hospitalaria fue del 17,8 % (8829/49.479). Los principales factores de riesgo asociados de forma independiente al desarrollo de MACE fueron la edad avanzada, la enfermedad renal crónica o la enfermedad cardiovascular, los antecedentes de tabaquismo y la necesidad de vasopresores o de ventilación mecánica invasiva en el momento del ingreso. La mortalidad global a 28 y a 90 días fue mayor entre los pacientes que desarrollaron MACE que entre los que no lo hicieron (63,1 % [5573/8829] frente a 35,6 % [14.487/40.650], p < 0,001; 69,9 % [6169/8829] frente a 37,8 % [15.372/40.650], p < 0,001, respectivamente). Tras ajustar por factores de confusión, los MACE siguieron asociándose de forma independiente a una mayor mortalidad a 28 y a 90 días (odds ratio [IC del 95 %]: 1,36 [1,33-1,39] y 1,47 [1,43-1,50], respectivamente). Conclusiones: Los pacientes con COVID-19 grave desarrollan MACE con frecuencia, lo que se asocia de forma independiente a peores resultados clínicos. [Traducción automática al español; idioma original: inglés.]Purpose: To determine its cumulative incidence, identify the risk factors associated with Major Adverse Cardiovascular Events (MACE) development, and its impact clinical outcomes. Materials and methods: This 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. Results: 49,479 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). Conclusions: Patients with severe COVID-19 frequently develop MACE, which is independently associated with worse clinical outcomes.4931997enghttp://creativecommons.org/licenses/by-nc-nd/4.0/COVID-19ComplicationsMajor adverse cardiovascular events (MACE)MortalityCritical Care and Intensive Care MedicineSDG 3 - Good Health and Well-beingJournal ArticleMulticenter StudyObservational StudyResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, Non-P.H.S.Yesyesjournal articleopen access10.1016/j.jcrc.2023.154318https://www.scopus.com/pages/publications/85158882967https://www.scopus.com/pages/publications/85158882967#tab=citedBy