Journal article
Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial
Stroke (1970), Vol.40(2), pp.412-418
02/2009
DOI: 10.1161/STROKEAHA.108.528778
PMCID: PMC2684783
PMID: 19095990
Abstract
Electrocardiographic abnormalities are common after subarachnoid hemorrhage, but their significance remains uncertain. The aim of this study was to determine whether any specific electrocardiographic abnormalities are independently associated with adverse neurological outcomes.
This was a substudy of the Intraoperative Hypothermia Aneurysm Surgery Trial, which was designed to determine whether intraoperative hypothermia would improve neurological outcome in patients with subarachnoid hemorrhage undergoing aneurysm surgery. The outcome was the 3-month Glasgow Outcome Score treated as both a categorical measure (Glasgow Outcome Score 1 [good outcome] to 5 [death]) and dichotomously (mortality/Glasgow Outcome Score 5 versus Glasgow Outcome Score 1 to 4). The predictor variables were preoperative electrocardiographic characteristics, including heart rate, corrected QT interval, and ST- and T-wave abnormalities. Univariate logistic regression was performed to screen for significant electrocardiographic variables, which were then tested for associations with the outcome by multivariate logistic regression adjusting for clinical covariates.
The study included 588 patients, of whom 31 (5%) died. There was a significant, nonlinear association between heart rate and mortality such that lowest quartile (<or=60 beats/min; OR, 6.5; P=0.027) and highest quartile (>80 beats/min; OR, 8.8; P=0.006) were associated with higher risk. There was also a significant association between nonspecific ST- and T-wave abnormalities and mortality (OR, 3.1; P=0.031).
Bradycardia, relative tachycardia, and nonspecific ST- and T-wave abnormalities are strongly and independently associated with 3-month mortality after subarachnoid hemorrhage. Further research should be performed to determine whether there is a causal relationship between cardiac dysfunction and neurological outcome after subarachnoid hemorrhage.
Details
- Title: Subtitle
- Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial
- Creators
- Landis A Coghlan - University of California, Los Angeles, California, USA. jonathan.g.zaroff@kp.orgBradley J HindmanEmine O BaymanNader M BankiAdrian W GelbMichael M ToddJonathan G ZaroffIHAST Investigators
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.40(2), pp.412-418
- Publisher
- United States
- DOI
- 10.1161/STROKEAHA.108.528778
- PMID
- 19095990
- PMCID
- PMC2684783
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Grant note
- R01 NS038554-05 / NINDS NIH HHS R01 NS38554 / NINDS NIH HHS R01 NS038554 / NINDS NIH HHS
- Language
- English
- Date published
- 02/2009
- Academic Unit
- Biostatistics; Anesthesia
- Record Identifier
- 9983997490602771
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