Cardiac complications in acute ischemic stroke.
BACKGROUND
To characterize cardiac complications in acute ischemic stroke (AIS) patients admitted from an urban emergency department (ED).


METHODS
Retrospective cross-sectional study evaluating AIS patients admitted from the ED within 24 hours of symptom onset who also had an echocardiogram performed within 72 hours of admission.


RESULTS
Two hundred AIS patients were identified with an overall in-hospital mortality rate of 8% (n = 16). In our cohort, 57 (28.5%) of 200 had an ejection fraction less than 50%, 35 (20.4%) of 171 had ischemic changes on electrocardiogram (ECG), 18 (10.5%) of 171 presented in active atrial fibrillation, 21 (13.0%) of 161 had serum troponin elevation, and 2 (1.1%) of 184 survivors had potentially lethal arrhythmias on telemetry monitoring. Subgroup analysis revealed higher in-hospital mortality rates among those with systolic dysfunction (15.8% versus 4.9%; P = 0.0180), troponin elevation (38.1% versus 3.4%; P < 0.0001), atrial fibrillation on ECG (33.3% versus 3.8%; P = 0.0003), and ischemic changes on ECG (17.1% versus 6.1%; P = 0.0398) compared with those without.


CONCLUSIONS
A proportion of AIS patients may have cardiac complications. Systolic dysfunction, troponin elevation, atrial fibrillation, or ischemic changes on ECG may be associated with higher in-hospital mortality rates. These findings support the adjunctive role of cardiac-monitoring strategies in the acute presentation of AIS.
Yale School of Medicine, Department of Emergency Medicine and Acute Stroke Service, New Haven, Connecticut.
Charles R
CR
Wira
Emanuel
E
Rivers
Cynthia
C
Martinez-Capolino
Brian
B
Silver
Gayathri
G
Iyer
Robert
R
Sherwin
Christopher
C
Lewandowski