Electrocardiogram markers predicting ischemic stroke after acute coronary syndrome
Matilda Hurskainen1, Juho Tynkkynen2, Leo-Pekka Lyytikäinen1,3
1Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Insights
Electrocardiogram (ECG) features like premature ventricular complexes and left ventricular hypertrophy predict ischemic stroke (IS) risk in acute coronary syndrome (ACS) patients. These ECG markers can help identify high-risk individuals for stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Patients with coronary artery disease (CAD) face a higher risk of ischemic stroke (IS).
- Identifying specific electrocardiogram (ECG) markers associated with IS risk in acute coronary syndrome (ACS) patients is crucial for risk stratification and prevention.
Purpose of the Study:
- To screen for significant ECG features that predict the risk of IS in patients treated for ACS.
- To identify specific ECG patterns indicative of increased IS risk post-ACS.
Main Methods:
- A retrospective registry study analyzed 7760 ACS patients with follow-up for incident IS.
- ECGs were analyzed using the Marquette™ 12SL™ ECG Analysis Program.
- Cox regression and subdistribution hazard (SDH) analyses were employed to identify significant ECG predictors after adjusting for relevant covariates.
Main Results:
- Among 7760 patients, 6.3% experienced IS during follow-up.
- Key predictors of IS included premature ventricular complexes (PVCs) or aberrantly conducted complexes in atrial fibrillation/flutter (AF/AFL), left ventricular hypertrophy (LVH), S wave amplitude in lead V4, and negative P wave peak time in lead V2.
- T wave amplitude in lead V6 and T wave duration in lead aVL showed an inverse association with IS risk.
Conclusions:
- ECG markers indicating left ventricular (LV) dysfunction, LVH, and atriopathy are associated with IS risk following ACS.
- These findings highlight the potential of ECG analysis for identifying ACS patients at higher risk of stroke, though external validation is necessary.
Background:
Patients with coronary artery disease (CAD) have increased risk of ischemic stroke (IS). Our aim was to screen for significant electrocardiogram (ECG) features for IS risk in patients treated for acute coronary syndrome (ACS).
Methods:
This retrospective registry study is based on 7760 ACS patients treated in Tays Heart Hospital (2007-2018) with follow-up for incident IS until December 31st, 2020. ECGs recorded during ACSs were analysed by the Marquette™ 12SL™ ECG Analysis Program version 24. Preliminary screening for ECG features was conducted using age- and sex adjusted Cox regression analysis and corrected by multiple testing (Bonferroni method). Highly correlated variables were excluded from the final age-, sex- and atrial fibrillation (AF)/atrial flutter (AFL) adjusted Cox regression and subdistribution hazard (SDH) multivariable analyses.
Results:
From 7760 patients, 489 (6.3 %) suffered IS during a median follow-up of 5.7 years (IQR 3.1-8.8). In the final multivariable model, the main risk factors were premature ventricular complexes (PVCs) or aberrantly conducted complexes in AF/AFL (SDH, 2.01 [1.22-3.31]), left ventricular (LV) hypertrophy (LVH) by Sokolow-Lyon criteria (SDH, 1.52 [1.12-2.06]), S wave amplitude in lead V4 (SDH, 1.13 [1.05-1.21]) and negative P wave peak time in lead V2 (SDH, 1.12 [1.02-1.23]). T wave amplitude in lead V6 (SDH, 0.78 [0.69-0.88]) and T wave duration in lead aVL (SDH, 0.85 [0.78-0.92]) showed an inverse association with IS risk. The continuous variables correspond to 1 SD.
Conclusions:
ECG markers demonstrating LV dysfunction, LVH and atriopathy associate with IS risk after ACS, although external validation is still required.
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