Abnormal ST segment in electrocardiograph predicts poor outcome in patients with acute subarachnoid hemorrhage

Background and purpose: There are high occurrences of abnormal electrocardio-graphic (ECG) in patients with acute subarachnoid hemorrhage (SAH). Thus, we want to determine whether any specific characteristics in ECG are associated with poor clinical outcomes in patients with SAH inhospital.

Methods: A total of 145 patient who selected from 270 cases with non-traumatic SAH was included in this study. A standard surface ECG was assessed for all patients within 72 hours of SAH onset. All patients were stratified into Good or Poor outcome groups according to the in-hospital mortality or neurological worsening (World Federation of Neurological Surgeons, WFNS class) when they discharge from our hospital.

Results: These patients in Poor outcome (n = 29) had significantly high heart rate (93.52± 22.23 bpm vs 78.42 ± 18 bpm, P < 0.01), prolonged QTc (458.17 ± 44.88 ms vs 436.89 ± 43.46 ms, P = 0.027) and corrected Tpeak–Tend interval (cTp-e, 106.19 ± 22.22 ms vs 93.14 ± 21.04 ms, P = 0.007) and high occurrence of ECG abnormalities including ST segment (90% vs 44%, P < 0.01) and left ventricular high voltage (28%vs 10%, P = 0.03). Multivariable logistic regression identified independent variables indicating poor outcome in-hospital including abnormal ST (OR = 2.507, 95% CI, 1.051-5.941, P = 0.037) and WFNS class (OR = 2.280, 95% CI, 1.605-3.240, P < 0.001).

Conclusions: Abnormal ST segment of ECG is an independent indicator for poor inhospital outcomes regardless the severity of patients with SAH and warrant to further study their mechanism in the future.

Subarachnoid hemorrhage; In-hospital prognosis; Electrocardiographic abnormalities; ST elevation and depression; QTc interval

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