2.3. Outcomes

The occurrence of cardiovascular complications was considered if any of the following appeared during hospitalization: (1) acute myocardial injury; (2) acute myocardial infarction (AMI), including non‐ST elevation or ST elevation MI; (3) new or worsening HF; (4) de novo arrhythmia; (5) deep vein thrombosis (DVT) or pulmonary embolism (PE).

This composite endpoint has been used in previous studies that evaluated the cardiovascular complications of pneumonia. 11 , 12 According to Fourth Universal Definition of Myocardial Infarction, 13 myocardial injury was diagnosed by the detection of elevated cardiac troponin with at least 1 value above the 99th percentile upper reference limit, and criteria for AMI were acute myocardial injury with at least one of the following: symptoms of myocardial ischemia; new ischemic electrocardiograph (ECG) changes; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality; identification of a coronary thrombus by angiography or autopsy. New or worsening HF was considered in patients with clinical signs (such as pulmonary edema, acute congestive HF, cardiomegaly, vascular congestion, etc.) and supportive findings on ECG or chest radiograph. 14 De novo arrhythmia was determined on the basis of a new episode of arrhythmia documented by ECGs during hospitalization, which was not detected before hospital admission. DVT or PE was considered on the basis of clinical manifestations and supportive findings of ultrasound or angiography CT.

Likewise, two doctors reviewed and checked the diagnosis of cardiovascular complications independently. Any disagreement was resolved through the third doctor and team discussion until consensus reached.