 |
|
Electrocardiographic Findings Predict Short-term Cardiac Morbidity After Transient Ischemic Attack
Jacob S. Elkins, MD;
Stephen Sidney, MD, MPH;
Daryl R. Gress, MD;
Alan S. Go, MD;
Allan L. Bernstein, MD;
S. Claiborne Johnston, MD, PhD
Arch Neurol. 2002;59:1437-1441.
Background Current guidelines recommend the use of electrocardiography (ECG) in
the evaluation of transient ischemic attack (TIA), but the data supporting
its value in acute management are sparse.
Objective To determine whether ECG findings are useful as independent predictors
of short-term cardiac or neurologic complications after TIA.
Methods We included patients who presented to 1 of 16 emergency departments
of a health maintenance organization in northern California and received a
diagnosis of TIA from March 1, 1997, through February 28, 1998, for a 90-day
follow-up. A cardiac event was defined as a hospitalization or a death due
to myocardial infarction, ventricular arrhythmia, heart failure, or unstable
angina.
Results Among the 1327 patients with TIA for whom ECG findings were available
for diagnostic coding, cardiac events occurred in 2.9%, strokes in 10.9%,
recurrent TIAs in 13.7%, and deaths in 2.6% during 90-day follow-up. The ECG
findings disclosed a new diagnosis of atrial fibrillation in 28 (2.3%) of
the 1200 patients with no history of this condition. The 90-day risk for a
cardiac event was greater in those who had any abnormal ECG findings (4.2%
vs 0.6%; P<.001). This association remained significant
after adjustment for medical history and examination findings (odds ratio,
6.9; 95% confidence interval, 1.6-29.5; P = .009).
Left ventricular hypertrophy, atrial fibrillation, and atrioventricular conduction
abnormalities were each independently associated with more than doubling of
the risk. The ECG abnormalities were not associated with risk for stroke or
death.
Conclusions Short-term cardiac morbidity is substantial after TIA. Electrocardiographic
findings disclose new atrial fibrillation in a significant portion of patients
with TIA and can identify a group of patients at a substantially higher risk
for short-term cardiac events.
From the Department of Neurology, University of California, San Francisco
(Drs Elkins, Gress, and Johnston); the Division of Research, Kaiser Permanente
of Northern California, Oakland (Drs Sidney, Go, and Johnston); and the Department
of Neurology, Kaiser Permanente Medical Center, Santa Rosa, Calif (Dr Bernstein).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists.
Easton et al.
Stroke 2009;40:2276-2293.
ABSTRACT
| FULL TEXT
Noninvasive Cardiac Monitoring for Detecting Paroxysmal Atrial Fibrillation or Flutter After Acute Ischemic Stroke: A Systematic Review
Liao et al.
Stroke 2007;38:2935-2940.
ABSTRACT
| FULL TEXT
Defining Cause of Death in Stroke Patients: The Brain Attack Surveillance in Corpus Christi Project
Brown et al.
Am J Epidemiol 2007;165:591-596.
ABSTRACT
| FULL TEXT
Emergency department evaluation of ischemic stroke and TIA: The BASIC Project
Brown et al.
Neurology 2004;63:2250-2254.
ABSTRACT
| FULL TEXT
A comparison of risk factors for recurrent TIA and stroke in patients diagnosed with TIA
Claiborne Johnston et al.
Neurology 2003;60:280-285.
ABSTRACT
| FULL TEXT
|
