In-Hospital ECG Findings, Changes in Medical Management, and Cardiovascular Outcomes in Patients With Acute Stroke or Transient Ischemic Attack

被引：9

作者：

Olma, Manuel C. ^{[1
,19
]}

Tutuncu, Serdar ^{[1
]}

Fiessler, Cornelia ^{[2
]}

Kunze, Claudia ^{[1
]}

Kraemer, Michael ^{[1
]}

Steindorf-Sabath, Lena ^{[1
]}

Jawad-Ul-Qamar, Muhammad ^{[3
]}

Kirchhof, Paulus ^{[3
,4
,5
]}

Laufs, Ulrich ^{[6
]}

Schurig, Johannes ^{[1
]}

Kraft, Peter ^{[7
,8
]}

Roether, Joachim ^{[9
]}

Guenther, Albrecht ^{[10
]}

Thomalla, Goetz ^{[11
]}

Dimitrijeski, Boris ^{[12
]}

Nabavi, Darius G. ^{[12
]}

Veltkamp, Roland ^{[13
,14
]}

Heuschmann, Peter U. ^{[2
,15
]}

Haeusler, Karl Georg ^{[7
]}

Endres, Matthias ^{[1
,16
,17
,18
,19
,20
,21
]}

机构：

[1] Charite Univ Med Berlin, Ctr Stroke Res Berlin, Berlin, Germany

[2] Univ Wurzburg, Inst Clin Epidemiol & Biometry, Wurzburg, Germany

[3] Univ Birmingham, Inst Cardiovasc Sci, Coll Med & Dent Sci, Med Sch, Birmingham, W Midlands, England

[4] Univ Heart & Vasc Ctr Hamburg, Hamburg, Germany

[5] German Ctr Cardiovasc Res, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany

[6] Univ Leipzig, Univ Hosp, Dept Cardiol, Leipzig, Germany

[7] Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany

[8] Hosp Main Spessart Lohr, Dept Neurol, Lohr, Germany

[9] Asklepios Hosp Altona, Dept Neurol, Hamburg, Germany

[10] Univ Jena, Dept Neurol, Jena, Germany

[11] Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Hamburg, Germany

[12] Vivantes Hosp Neukolln, Dept Neurol, Berlin, Germany

[13] Alfried Krupp Hosp, Dept Neurol, Essen, Germany

[14] Imperial Coll London, Dept Brain Sci, London, England

[15] Univ Hosp Wurzburg, Clin Trial Ctr Wurzburg, Wurzburg, Germany

[16] German Ctr Neurodegenerat Dis DZNE, Berlin, Germany

[17] German Ctr Cardiovasc Res DZHK, Partner Site Berlin, Berlin, Germany

[18] Excellence Cluster NeuroCure, Berlin, Germany

[19] BIH, Berlin, Germany

[20] Charite Univ Med Berlin, Dept Neurol Expt Neurol, Berlin, Germany

[21] Charite Univ Med Berlin, Berlin, Germany

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2023年 / 12卷 / 02期

关键词：

beta-blocker; ECG; mortality; stroke; transient-ischemic attack; RESTING HEART-RATE; ATRIAL-FIBRILLATION; MORTALITY; IMPACT; ADMISSION;

D O I：

10.1161/JAHA.122.027149

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: In patients with acute ischemic stroke, little is known regarding the frequency of abnormal ECG findings other than atrial fibrillation and their association with cardiovascular outcomes. We aim to analyze the frequency and type of abnormal ECG findings, subsequent changes in medical treatment, and their association with cardiovascular outcomes in patients with acute ischemic stroke.METHODS AND RESULTS: In the investigator-initiated multicenter MonDAFIS (impact of standardized monitoring for detection of atrial fibrillation in ischemic stroke) study, 3465 patients with acute ischemic stroke or transient ischemic attack and without known atrial fibrillation were randomized 1:1 to receive Holter- ECG for up to 7 days in-hospital with systematic evaluation in a core cardiology laboratory (intervention group) or standard diagnostic care (control group). Outcomes included predefined abnormal ECG findings (eg, pauses, atrial fibrillation, brady-/tachycardias), medical management in the intervention group, and combined vascular end point (recurrent stroke, myocardial infarction, major bleeds, or all -cause death) and mortality at 24 months in both randomization groups. Predefined abnormal ECG findings were detected in 326 of 1693 (19.3%) patients in the intervention group. Twenty of these 326 patients (6.1%) received a pacemaker, and 62 of 326 (19.0%) patients had newly initiated or discontinued (3- blocker medication. Discontinuation of (3- blockers was associated with a higher death rate in the control group than in the intervention group during 24 months after enrollment (adjusted hazard ratio, 11.0 [95% CI, 2.4- 50.4]; P=0.025 for interaction).CONCLUSIONS: Systematic in-hospital Holter ECG reveals abnormal findings in 1 of 5 patients with acute stroke, and mortality was lower at 24 months in patients with systematic ECG recording in the hospital. Further studies are needed to determine the potential impact of medical management of abnormal ECG findings.

引用

页数：21

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