The 12-lead electrocardiogram in patients with subarachnoid hemorrhage: early risk prognostication

ObjectiveThe aim of this study was to investigate if the electrocardiographic (ECG) abnormalities assessed early in the emergency department (ED) are associated with the in-hospital mortality of the patients with spontaneous subarachnoid hemorrhage (SAH).MethodsWe studied prospectively a cohort of 222 adult patients with spontaneous SAH in an ED. A 12-lead ECG was performed for these patients in the ED. The patients were stratified into nonsurvivors and survivors based on the in-hospital mortality. The clinical characteristics, heart rate, corrected QT interval (QTc) and 7 predefined morphologic abnormalities were compared between these 2 groups of patients.ResultsCompared with the survivors (n = 178), the nonsurvivors (n = 44) had significantly slower heart rate (75 ± 23 vs 83 ± 16, P = .018) and more prolonged QTc (492 ± 58 vs 458 ± 40, P = .001). There were significantly higher frequency of occurrence of ECG morphologic abnormalities (66% vs 37%, P = .001) and nonspecific ST- or T-wave changes (NSSTTCs; 32% vs 12%, P = .015) in the nonsurvivors compared with those in the survivors. Multiple logistic regression model identified QTc (odds ratio, 1.0; 95% confidence interval, 1.0-1.0; P = .005) and NSSTTC (odds ratio, 3.3; 95% confidence interval, 1.0-10.7; P = .047) as the significant ECG variables associated with in-hospital mortality.ConclusionsThe occurrence of NSSTTC and prolonged QTc assessed early in the ED are independently associated with the in-hospital mortality in adult patients with spontaneous SAH.