Electrocardiographic changes in patients with acute stroke in the prehospital setting and their prognostic importance

Introduction

Electrocardiographic (ECG) changes can be observed in patients with acute stroke without primary heart disease. The aim of the study was to determine whether ischaemic ECG changes and arrythmia are related to prognosis in this population of patients.

Patients and methods

This prospective observational cohort study consisted of 309 patients (168 male and 141 female, age 68.7 ± 31.5 years) with first stroke presenting to prehospital emergency physicians in the field during 6 years (March 1999–February 2005). Among all patients, 258 had ischaemic stroke (IS) and 51 had haemorrhagic stroke (HS). Patients with transient ischaemic attack were excluded from the study. Six-month mortality was analysed by means of ischaemia-like ECG changes (ST segment, inverted T wave, abnormal U wave), and arrythmia.

Results

The members of the IS group were significantly older than those in HS group (73 ± 30 vs 52 ± 23 years; P < 0.05). The frequency of the ECG changes observed in patients with IS was 69% (178/258) while in patients with HS it was 31% (16/51; P < 0.05). In the IS group 81 patients (31%) had ischaemia-like changes and 96 (37%) had arrythmia. The HS group had significantly less ECG changes (15% had ischaemia-like changes and 11% had arrythmia; P < 0.05). The HS group had significantly more patients with bradycardia than the IS group (24% vs 4%; P < 0.05). The 6-month mortality rate in patients with ECG changes was 29% (56/ 194) whereas it was 16% (18/115) in those with normal ECG. In multivariate analyses the 6-month mortality in patients with IS was predicted by atrial fibrillation (OR 2.2, 95% CI 1.5–3.7) and ischaemia-like ECG changes (OR 2.1, 95% CI 0.9–3.8). In patients with HS, sinus bradycardia predicted poor outcome (OR 3.9; 95% CI 1.4–9.8).

Conclusion

ECG abnormalities are frequent in acute stroke and may predict 6-month mortality. The observations of this study suggest differences between the IS and HS group. The ECG evaluation of patients with acute stroke must be started at the field. Whether the ECG changes are the result of some generalized atherosclerosis that promotes acute stroke, or the magnitude and perhaps location of brain infarction promotes ECG changes in the reverse direction, remains the question.