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Electrocardiographic score as a predictor of mortality after subarachnoid hemorrhage
Tatsuya Kawasaki1, Akihiro Azuma, Takahisa Sawada
1Second Department of Medicine, Kyoto Prefectural University of Medicine, Japan. js-k@wf6.so-net.ne.jp
Insights
Electrocardiogram (ECG) abnormalities can predict outcomes in subarachnoid hemorrhage (SAH) patients. A simple ECG score effectively identifies patients at higher risk of in-hospital death following SAH.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Electrocardiographic (ECG) changes are frequently observed in patients with subarachnoid hemorrhage (SAH).
- The prognostic significance of these ECG changes in SAH patients remains incompletely understood.
Purpose of the Study:
- To investigate the prognostic value of ECG abnormalities in patients with aneurysmal SAH.
- To develop and validate a simple scoring system for risk stratification in SAH.
Main Methods:
- Retrospective analysis of 122 consecutive patients with aneurysmal SAH.
- Classification of patients based on in-hospital outcomes (survivors vs. nonsurvivors).
- Definition of an ECG score based on the presence of abnormal Q waves, ST depression, and T wave inversion across 12 leads.
Main Results:
- Nonsurvivors frequently exhibited abnormal Q waves, ST depression, and T wave inversion on ECG.
- Univariate analysis showed correlations between in-hospital death and ECG score, neurological status (Hunt and Kosnik grade), age, and QTc interval.
- Age- and sex-adjusted logistic regression identified the ECG score as the most powerful risk stratifier (OR 14.39 for ECG score ≥ 6).
Conclusions:
- The developed ECG score is a simple and powerful predictor of in-hospital mortality in SAH patients.
- This semi-quantitative ECG scoring method aids in risk stratification for SAH.
- ECG assessment provides valuable prognostic information in the context of subarachnoid hemorrhage.
Abstract:
Electrocardiographic (ECG) changes are often associated with subarachnoid hemorrhage (SAH), but it is not well known whether these have prognostic value. The present study retrospectively investigated 122 consecutive patients with SAH caused by ruptured aneurysms. The patients were classified based on the in-hospital outcome into 80 survivors and 42 nonsurvivors. In nonsurvivors, abnormalities often observed on the 12-lead ECG on arrival at hospital were abnormal Q wave, ST depression, and T wave inversion. The ECG score was defined as the total number of leads that had any of these 3 ECG abnormalities. Univariate analysis revealed a strong correlation of in-hospital death with the ECG score, the neurological status estimated by the grading of Hunt and Kosnik, age, and QTc interval. In age- and sex-adjusted multiple logistic regression analysis, the ECG score was the most powerful risk stratifier (ECG score > or = 6 vs ECG score < 6; p=0.0026, odds ratio 14.39, 95% confidence interval 2.54-81.71). The ECG score, a new and simple method of semi-quantification, was a powerful risk predictor in the present patients with SAH.