Ventricular repolarization abnormalities in acute ischemic stroke

We evaluated the prevalence and clinical impact of ST-segment depression and/or T-wave inversion (ST-T changes) assessed on a standard electrocardiogram (ECG) among patients with an acute ischemic stroke (AIS).

We included adult patients admitted with AIS between October 2020 and June 2022. Clinical data, admission ECG, and in-hospital outcomes were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). The primary endpoint was a composite of severe stroke (NIHSS>5 at discharge) or in-hospital mortality, as well as length of hospital stay.

A total of 221 patients with AIS were analyzed (71.8±12.8 years, 56% male). Baseline ECG abnormalities were present in 170 (77%) patients. The most frequents findings were ST-T changes (n=80, 36%), intraventricular conduction disturbances (n=71, 32%), and atrial fibrillation (AF) (n=65, 29%). During hospitalization, 20 (9%) patients died and 64 (32%) had NIHSS>5 at discharge. Hospital stay was longer in patients with AF [9.0 (6.5; 20.5) days] vs. those without AF [5.0 (3.0; 11.0) days, p<0.0001], and in those with ST-T changes [9.0 (4.0; 21.0) days] vs. those without ST-T changes [5.0 (3.0; 10.0) days, p<0.0001]. The presence of abnormal ECG (p<0.0001), AF (p=0.027), and ST-T changes (p<0.0001) were associated with the composite endpoint. In the logistic regression analysis, ST-T changes were the only predictor (OR 3.7; 95% CI 2.0-6.8; p<0.0001).

Baseline ST-T abnormalities on admission ECG are predictors of worsening stroke severity and in-hospital outcomes in AIS.