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Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities
J G Zaroff1, G A Rordorf, J B Newell
1Cardiac Unit, Massachusetts General Hospital, Boston, USA.
Insights
Patients with subarachnoid hemorrhage (SAH) and ECG changes indicating myocardial ischemia or infarction have a low risk of cardiac death. These ECG abnormalities correlate with severe neurological injury but do not independently predict overall mortality.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) frequently presents with electrocardiographic (ECG) abnormalities suggestive of myocardial ischemia or infarction.
- The cardiac prognosis for SAH patients with these ECG changes is not well-established.
Purpose of the Study:
- To determine the cardiac and all-cause mortality rates in patients with SAH who exhibit ECG changes indicative of myocardial ischemia or infarction.
Main Methods:
- A retrospective study identified SAH patients with abnormal ECGs within 3 days of presentation and before aneurysm surgery.
- A control group of SAH patients without ECG abnormalities was also analyzed.
- Cardiac mortality was assessed via chart review, defining death from arrhythmia, heart failure, or cardiogenic shock.
Main Results:
- Of 439 SAH patients, 58 had ECG abnormalities. No cardiac deaths occurred in the study group.
- Twenty patients died from noncardiac causes.
- Older age (>65 years) and higher Hunt and Hess grade (≥3) predicted all-cause mortality, while ECG abnormalities did not.
Conclusions:
- SAH patients with ECG changes consistent with ischemia or MI have a low risk of cardiac death, irrespective of aneurysm surgery.
- ECG abnormalities in SAH are linked to more severe neurological injury but are not independent predictors of all-cause mortality.
Objective:
Approximately 25% of patients with subarachnoid hemorrhage (SAH) have electrocardiographic (ECG) abnormalities consistent with myocardial ischemia or myocardial infarction (MI), and their cardiac prognosis remains unclear. The objective of this study was to determine the cardiac and all-cause mortality rate of a series of patients with SAH with ECG changes consistent with ischemia or MI.
Methods:
Using an existing database of patients with SAH and predetermined ECG criteria for ischemia or MI, a study group of patients with abnormal ECG results within 3 days of presentation and before aneurysm surgery was identified. Database patients without abnormal ECG results served as a control group. Cardiac mortality, defined as death resulting from arrhythmia, congestive heart failure, or cardiogenic shock, was assessed by chart review.
Results:
Of 439 patients with SAH in the database, 58 met the criteria for the study group. Forty-one of these patients were treated neurosurgically. No deaths resulting from cardiac causes occurred, and 20 patients died as a result of noncardiac causes. In a multivariable analysis, age older than 65 years and Hunt and Hess grade of at least 3 were predictive of all-cause mortality. ECG abnormalities, however, were not a statistically significant predictor.
Conclusion:
In patients with SAH and ECG readings consistent with ischemia or MI, the risk of death resulting from cardiac causes is low, with or without aneurysm surgery. The ECG abnormalities are associated with more severe neurological injury but are not independently predictive of all-cause mortality.