Background: COVID-19 can cause acute and chronic cardiovascular complications. Acute complications include heart failure, coronary syndrome, arrhythmias, myocarditis, pulmonary embolism, etc. These complications are linked to pre-existing cardiovascular disease (CVD) and increase the risk of adverse outcomes. We characterized acute cardiovascular complications in COVID-19 patients from 32 countries. Methods: This cohort study combined two prospective, multicenter studies of hospitalized adults with COVID-19: the CARDIO COVID 19–20 registry and the WHF COVID-19 CVD study. We performed descriptive and multivariate analyses to assess the incidence of cardiovascular complications, associated factors, and their correlation with mortality. Results: We included 8045 patients from the Americas, Africa, Asia, and Europe. Median age was 59 years (IQR 47–69), and 60.9 % were male. Cardiovascular complications occurred in 1072 patients (13.3 %), most commonly arrhythmias (448, 5.5 %), acute heart failure (441, 5.4 %), and pulmonary embolism (227, 2.8 %). Patients with CVD had higher complication rates (33.1 % vs. 10.2 %), more ICU admissions (56 % vs. 36.7 %), and higher in-hospital mortality (40.4 % vs. 13.2 %). The incidence of complications was highest in the Americas (18.4 %) and Europe (14.9 %). Risk factors included age and cardiometabolic comorbidities. Regression analysis showed that having ≥1 cardiovascular complication increased the risk of in-hospital mortality (aRR 2.32, 95 % CI 2.10–2.55, p < 0.001). Conclusions: Cardiovascular complications affected over 10 % of hospitalized patients, with regional variations. These events were associated with higher mortality and were highly prevalent among those with CVD.