Electrocardiographic Findings in COVID-19: Insights on Mortality and Underlying Myocardial Processes

McCullough, S. Andrew; Goyal, Parag; Krishnan, Udhay; Choi, Justin J.; Safford, Monika M.; Okin, Peter M.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a respiratory syndrome with high rates of mortality, and there is a need for easily obtainable markers to provide prognostic information. We sought to determine whether the electrocardiogram (ECG) on hospital presentation provides prognostic information, specifically related to death. METHODS: We performed a retrospective cohort study in patients with COVID-19 who had an ECG at or near hospital admission. Clinical characteristics and ECG variables were manually abstracted from the electronic health record and first ECG. Our primary outcome was death. RESULTS: 756 patients who presented to a large New York City teaching hospital with COVID-19 underwent an ECG. The mean age was 63.3 ± 16 years, 37% were women, 61% of patients were non-white, and 57% had hypertension; 90 (11.9%) died. In a multivariable logistic regression that included age, ECG, and clinical characteristics, the presence of one or more atrial premature contractions (APC)s (odds ratio (OR)=2.57, 95% confidence interval (CI) 1.23-5.36, p=0.01), a right bundle branch block (RBBB) or intraventricular block (IVB) (OR=2.61, 95% CI 1.32-5.18, p=0.002), ischemic T-wave inversion (OR=3.49, 95% CI 1.56-7.80, p=0.002), and nonspecific repolarization (OR=2.31, 95% CI 1.27-4.21, p=0.006) increased the odds of death. ST elevation was rare (n=5, 0.7%). CONCLUSION: We found that patients with ECG findings of both left sided heart disease (APCs, IVB, repolarization abnormalities) and right sided disease (RBBB) have higher odds of death. ST elevation at presentation was rare.