Key result
Electrocardiographic alterations were present in 59.2% of patients with acute aneurysmal subarachnoid hemorrhage and independently predicted poor discharge neurological status, but did not independently predict mortality.
Why the study?
Do electrocardiographic alterations predict mortality or poor neurological outcome in patients with acute aneurysmal subarachnoid hemorrhage?
Cohort (n=321)
No
Do electrocardiographic alterations predict mortality or poor neurological outcome in patients with acute aneurysmal subarachnoid hemorrhage?
Odds Ratio: 5.74 (95% CI 2.4–13.78)
Absolute Event Rate: 19.1% vs 4%
p-value: p=<0.01
In patients with acute aneurysmal SAH, ECG alterations are common and independently predict poor discharge neurological status, but do not independently predict death.
May identify aSAH patients at higher risk of poor neurological outcome; leaves open whether ECG monitoring improves stratification or care.
Electrocardiographic (ECG) alterations occurring after subarachnoid hemorrhage (SAH) have been described frequently, but the prognostic significance of these changes has not been well characterized. To report the prevalence and patterns of ECG alterations in patients with acute aneurysmal SAH and to study the relationship between ECG alterations and the neurological outcome, if any. Records of consecutive patients admitted to the neurosurgical intensive care unit of the SCTIMST, Trivandrum between January 1999 and January 2011 with acute aneurysmal SAH were retrospectively analyzed. Of the 321 patients with SAH, 190 (59.2%) had abnormal ECGs. Repolarization abnormalities were the most common, with T wave inversion in the anterolateral leads occurring in 155 (48.3%) patients. By univariate analysis, female sex, Glasgow Coma Score (GCS) at admission of <15, World Federation of Neurological Surgeons (WFNS) grade >I, ST segment depression or T inversion in anterolateral leads, prolonged corrected QT interval, and sinus bradycardia were associated with increased risk of death. By multivariate analysis, only GCS and WFNS grade independently predicted mortality and none of the ECG changes predicted the same. Presence of tall T waves in anterior leads, T inversion in anterolateral leads, sinus bradycardia, and WFNS grade >1 were independently associated with GCS <15 and poor outcome at discharge. In patients with acute aneurysmal SAH, repolarization abnormalities are the commonest ECG alterations. ECG alterations do not independently predict death, but independently predict poor discharge neurological status.
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Choudhary et al. (2013) conducted a cohort in Acute aneurysmal subarachnoid hemorrhage (n=321). ST depression in anterolateral leads vs. Absence of ST depression in anterolateral leads was evaluated on In-hospital death (univariate analysis) (OR 5.74, 95% CI 2.40-13.78, p=<0.01). Electrocardiographic alterations were present in 59.2% of patients with acute aneurysmal subarachnoid hemorrhage and independently predicted poor discharge neurological status, but did not independently predict mortality.
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