Electrocardiography on admission is associated with poor outcomes in coronavirus disease 2019 (COVID‐19) patients: A systematic review and meta‐analysis

Alsagaff, Mochamad Yusuf; Oktaviono, Yudi Her; Dharmadjati, Budi Baktijasa; Lefi, Achmad; Al‐Farabi, Makhyan Jibril; Gandi, Parama; Marsudi, Bagas Adhimurda; Azmi, Yusuf

BACKGROUND: Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID‐19) patients. A systematic review and meta‐analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID‐19. METHODS: A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID‐19 patients. RESULTS: A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62‐9.45], P = .001; I (2):0%] and [RR 1.89 [1.52‐2.36], P < .001; I (2):17%], respectively). Patients with poor outcome had a longer QRS duration and a faster heart rate compared with patients with good outcome ([WMD 2.03 [0.20‐3.87], P = .030; I (2):46.1%] and [WMD 5.96 [0.96‐10.95], P = .019; I (2):55.9%], respectively). The incidence of left bundle branch block (LBBB), premature atrial contraction (PAC), and premature ventricular contraction (PVC) were higher in patients with poor outcome ([RR 2.55 [1.19‐5.47], P = .016; I (2):65.9%]; [RR 1.94 [1.32‐2.86], P = .001; I (2):62.8%]; and [RR 1.84 [1.075‐3.17], P = .026; I (2):70.6%], respectively). T‐wave inversion and ST‐depression were more frequent in patients with poor outcome ([RR 1.68 [1.31‐2.15], P < .001; I (2):14.3%] and [RR 1.61 [1.31‐2.00], P < .001; I (2):49.5%], respectively). CONCLUSION: Most ECG abnormalities on admission are significantly associated with an increased composite poor outcome in patients with COVID‐19.