Background: Acute myocardial injury (AMJ), assessed by elevated levels of cardiac
troponin, is associated with fatal outcome in coronavirus disease 2019 (COVID-19).
However, the role of acute cardiovascular (CV) events defined by clinical manifestation
rather than sole elevations of biomarkers is unclear in hospitalized COVID-19 patients.
Objective: The aim of this study was to investigate acute clinically manifest CV events
in hospitalized COVID-19 patients. Methods: From 1 March 2020 to 5 January 2021, we
conducted a multicenter, prospective, epidemiological cohort study at six hospitals
from Hamburg, Germany (a portion of the state-wide 45-center CORONA Germany cohort
study) enrolling all hospitalized COVID-19 patients. Primary endpoint was occurrence
of a clinically manifest CV-event. Results: In total, 132 CV-events occurred in 92
of 414 (22.2%) patients in the Hamburg-cohort: cardiogenic shock in 10 (2.4%), cardiopulmonary
resuscitation in 12 (2.9%), acute coronary syndrome in 11 (2.7%), de-novo arrhythmia
in 31 (7.5%), acute heart-failure in 43 (10.3%), myocarditis in 2 (0.5%), pulmonary-embolism
in 11 (2.7%), thrombosis in 9 (2.2%) and stroke in 3 (0.7%). In the Hamburg-cohort,
mortality was 46% (42/92) for patients with a CV-event and 33% (27/83) for patients
with only AMJ without CV-event (OR 1.7, CI: (0.94-3.2), p = 0.077). Mortality was
higher in patients with CV-events (Odds ratio(OR): 4.8, 95%-confidence-interval(CI):
[2.9-8]). Age (OR 1.1, CI: (0.66-1.86)), atrial fibrillation (AF) on baseline-ECG
(OR 3.4, CI: (1.74-6.8)), systolic blood-pressure (OR 0.7, CI: (0.53-0.96)), potassium
(OR 1.3, CI: (0.99-1.73)) and C-reactive-protein (1.4, CI (1.04-1.76)) were associated
with CV-events. Conclusion: Hospitalized COVID-19 patients with clinical manifestation
of acute cardiovascular events show an almost five-fold increased mortality. In this
regard, the emergence of arrhythmias is a major determinant.
