241: New ECG Changes Noted In Primary Intracerebral Hemorrhage and Their Association With Outcomes

Abstract

To investigate if patients with primary non-traumatic intra-cerebral hemorrhage (ICH) developed any new changes in ST-T and ECG rhythms and their association with outcome and early mortality. The cohort selected included all patients presenting to the emergency department (ED) from January 2006 to December 2008, with a confirmed ICH on CT scan and 12 lead ECG on presentation. Stroke severity at admission and functional outcome (modified rankin score mRs) at discharge was recorded. Comparison of ECGs with noticeable ST-T changes and rhythm abnormalities to the most recent ECG prior to ICH was done. Of the total cohort of 227 ICH patients presenting to the ED, 167 ECGs had abnormality in ST-T segment or rhythm (41 ECGs - only ST-T segments, 60 ECGs - only rhythm, 66 ECGs - with both). Of these, 111 patients had a previous ECG available. New rhythm changes were found in 43 patients. The most common new abnormality found was a partial or complete left bundle branch block (27.9% n=12), followed by 1st degree AV block (23.3% n=10). Atrial flutter/fibrillation was found to have newly developed in 7 patients (16.3%) and newly premature supraventricular and ventricular complexes in 20.9% and 18.6% patients respectively. These patients with new rhythm changes post ICH had more severe strokes (median NIHSS- 9, IQR 3-35) and worse functional outcome at discharge (median mRs 5, IQR 4-6) as compared to those without new rhythm abnormalities (median NIHSS 6.5, IQR 2-13, p=0.017; median mRs 4, IQR .25-5, p=0.0001). They were also found to have 3.12 times higher relative risk of death within 7 days (95% CI 1.79-5.43; p<0.0001) and a 2.32 times higher relative risk of death at 30 days (95% CI 1.46 - 3.69, p=0.0005) post ICH when compared to those without new changes. New ST-T changes post ICH was found in 46 patients. These patients had worse functional outcome at discharge (median mRs 5, IQR 1-6) as compared to those without any new ST-T changes (median mRs 4, IQR 0.75-5, p=0.018). Patients with new ST-T changes had a 1.94 times higher relative risk of mortality at 30 days, 95% CI 1.18-3.2, p=0.01. ICH causes new changes in ECGs. New rhythm and ST-T changes are also associated with worse functional outcome and a higher likelihood of mortality at 1 month.