What is the clinical evidence from this study?

Study design: RCT. Population: acute ischemic stroke or transient ischemic attack (TIA) (n=1369). Intervention: Admission Bazett-corrected QT-interval (QTc). Primary outcome: MACCE (recurrent stroke, myocardial infarction, major bleeding, or death) (HR 1.40, 95% CI 1.14-1.72, p=0.001).

What question did this study set out to answer?

To evaluate the association between QTc interval on admission ECG and clinical outcomes after ischemic stroke or TIA.

May 8, 2026Open Access

Abstract Number: Esoc2026a1319 Admission QTC-Interval on Standard 12-Lead Ecg Is Associated With Clinical Outcomes Over 24 Months After Ischemic Stroke or Transient Ischemic Attack

Key Result

Per 1 standard deviation increase, admission QTc was associated with an increased risk of MACCE (HR 1.40; 95% CI 1.14-1.72; p=0.001) over 24 months after ischemic stroke or TIA.

Key Points

To evaluate the association between QTc interval on admission ECG and clinical outcomes after ischemic stroke or TIA.
Randomized patients without atrial fibrillation in the MonDAFIS trial (N=3,465) for prolonged Holter-ECG monitoring.
Post-hoc analysis of intervention group measuring QTc with manual calipers.
Multivariable Cox regression models adjusted for age, sex, stroke severity, and cardiovascular comorbidities.
QTc assessment feasible in 1,369/1,714 patients with a median QTc of 408 ms for men and 416 ms for women.
Each standard deviation increase in QTc was associated with MACCE (HR 1.40, 95%CI 1.14-1.72, p=0.001) and mortality (HR 1.66, 95%CI 1.16-2.36, p=0.001).
Prolonged QTc (≥450 ms for men; ≥460 ms for women) was linked to mortality (HR 2.68, 95%CI 1.33-5.40, p=0.006).

Study Design

Type

RCT (n=1,369)

Structured PICO

Does admission QTc-interval on standard 12-lead ECG predict MACCE, mortality, and recurrent stroke in patients with ischemic stroke or TIA?

Population

1,369 patients with ischemic stroke or transient ischemic attack (TIA) without known atrial fibrillation (analyzed from the intervention group of the MonDAFIS trial). Excluded: patients with QRS>120 ms due to left bundle branch block or nonspecific intraventricular conduction delay.

Intervention

Higher admission Bazett-corrected QT-interval (QTc) on standard 12-lead ECG (analyzed continuously per 1 standard deviation increase, and dichotomously as prolonged QTc: ≥ 450 ms in men; ≥ 460 ms in women)

Comparator

Lower or normal admission QTc on standard 12-lead ECG

Outcome

MACCE (composite of recurrent stroke, myocardial infarction, major bleeding, or death) over 24 monthscomposite

Higher admission QTc on a standard 12-lead ECG is significantly associated with an increased risk of MACCE, mortality, and recurrent stroke over 24 months in patients with ischemic stroke or TIA.

Main Result

Effect estimate: HR 1.40 (95% CI 1.14-1.72)

p-value: p=0.001

Abstract

Abstract Background and aims We evaluated the association between admission Bazett-corrected QT-interval (QTc) on 12-lead ECGs and clinical outcomes after acute ischemic stroke or transient ischemic attack (TIA). Methods MonDAFIS randomised patients with ischemic stroke/TIA without known atrial fibrillation to prolonged in-hospital Holter-ECG (N=3,465). In this post-hoc analysis of the intervention group (manual caliper QT-interval measurement) QTc on the routine 12-lead ECG on admission was related to MACCE (recurrent stroke, myocardial infarction, major bleeding, or death), recurrent stroke, and mortality over 24 months. Patients with QRS120 ms due to left bundle branch block or nonspecific intraventricular conduction delay were excluded. Multivariable Cox regression models were adjusted for age, sex, stroke severity (NIHSS5), and cardiovascular comorbidities. Results QT-interval assessment was feasible in 1,369/1,714 patients. Median QTc was 408 ms (IQR 389-428) in men and 416 ms (IQR 400-434) in women. Prolonged QTc (≥ 450 ms in men; ≥ 460 ms in women) occurred in 107/1,369 patients (7.8%). Per 1 standard deviation increase, z-standardised QTc was associated with MACCE (HR 1.40, 95%CI 1.14-1.72, p=0.001), mortality (HR 1.66, 95%CI 1.16-2.36, p=0.001), and recurrent stroke (HR 1.38, 95%CI 1.07-1.77, p=0.012). When analysed dichotomously, prolonged QTc was associated with mortality (HR 2.68, 95%CI 1.33-5.40, p=0.006), but not with MACCE or recurrent stroke. Conclusions Higher QTc was associated with increased risk of MACCE, mortality, and recurrent stroke after ischemic stroke/TIA. The recurrent stroke association was evident for continuous QTc but not for established cut-offs. QTc may help identify patients who could benefit from intensified follow-up. Conflict of interest This work was supported by an unrestricted research grant from Bayer Vital GmbH, Germany. MCO, MB, ST, FS and CK do not have potential conflicts of interests outside the submitted work. ME reports grants from Bayer and fees paid to the Charité from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Covidien, Daiichi Sankyo, Glaxo Smith Kline, Novartis, Pfizer and Sanofi,all outside the submitted work. KGH reports speaker's honoraria, consulting fees, lecture honoraria and/or study grants from Abbott, Amarin; AstraZeneca, Bayer Healthcare, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Edwards Lifesciences, Medronic, Novartis, Pfizer, Portola, Premier Research, Sanofi, SUN Pharma, and W.L. Gore and Associates. RBS has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 648131, from the European Union’s Horizon 2020 research and innovation programme under the grant agreement No. 847770 (AFFECT-EU), from the European Union’s Horizon Europe research and innovation programme under the grant agreement ID: 101095480 and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103 and 81Z0710114); German Ministry of Research and Education (BMBF 01ZX1408A) and ERACoSysMed3 (031L0239). Wolfgang Seefried project funding German Heart Foundation. RBS has received lecture fees and advisory board fees from BMS/Pfizer and Bayer outside this work.