The prognostic significance of electrocardiography findings in patients with coronavirus disease 2019: A retrospective study

Yang, Deyan; Li, Jing; Gao, Peng; Chen, Taibo; Cheng, Zhongwei; Cheng, Kangan; Deng, Hua; Fang, Quan; Yi, Chunfeng; Fan, Hongru; Wu, Yonghong; Li, Liwei; Fang, Yong; Tian, Guowei; Pan, Wan; Zhang, Fan

BACKGROUND: Coronavirus disease 2019 (COVID‐19) has reached a pandemic level. Cardiac injury is not uncommon among COVID‐19 patients. We sought to describe the electrocardiographic characteristics and to identify the prognostic significance of electrocardiography (ECG) findings of patients with COVID‐19. HYPOTHESIS: ECG abnormality was associated with higher risk of death. METHODS: Consecutive patients with laboratory‐confirmed COVID‐19 and definite in‐hospital outcome were retrospectively included. Demographic characteristics and clinical data were extracted from medical record. Initial ECGs at admission or during hospitalization were reviewed. A point‐based scoring system of abnormal ECG findings was formed, in which 1 point each was assigned for the presence of axis deviation, arrhythmias, atrioventricular block, conduction tissue disease, QTc interval prolongation, pathological Q wave, ST‐segment change, and T‐wave change. The association between abnormal ECG scores and in‐hospital mortality was assessed in multivariable Cox regression models. RESULTS: A total of 306 patients (mean 62.84 ± 14.69 years old, 48.0% male) were included. T‐wave change (31.7%), QTc interval prolongation (30.1%), and arrhythmias (16.3%) were three most common found ECG abnormalities. 30 (9.80%) patients died during hospitalization. Abnormal ECG scores were significantly higher among non‐survivors (median 2 points vs 1 point, p < 0.001). The risk of in‐hospital death increased by a factor of 1.478 (HR 1.478, 95% CI 1.131–1.933, p = 0.004) after adjusted by age, comorbidities, cardiac injury and treatments. CONCLUSIONS: ECG abnormality was common in patients admitted for COVID‐19 and was associated with adverse in‐hospital outcome. In‐hospital mortality risk increased with increasing abnormal ECG scores.