| Autor: |
Olma MC; Center for Stroke Research Berlin Charité - Universitätsmedizin Berlin Berlin Germany.; Berlin Institute of Health (BIH) Berlin Germany., Tütüncü S; Center for Stroke Research Berlin Charité - Universitätsmedizin Berlin Berlin Germany., Fiessler C; Institute of Clinical Epidemiology and Biometry University Würzburg Würzburg Germany., Kunze C; Center for Stroke Research Berlin Charité - Universitätsmedizin Berlin Berlin Germany., Krämer M; Center for Stroke Research Berlin Charité - Universitätsmedizin Berlin Berlin Germany., Steindorf-Sabath L; Center for Stroke Research Berlin Charité - Universitätsmedizin Berlin Berlin Germany., Jawad-Ul-Qamar M; Institute of Cardiovascular Sciences College of Medical and Dental Sciences, Medical School University of Birmingham Birmingham United Kingdom., Kirchhof P; Institute of Cardiovascular Sciences College of Medical and Dental Sciences, Medical School University of Birmingham Birmingham United Kingdom.; University Heart and Vascular Center Hamburg Hamburg Germany.; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck Hamburg Germany., Laufs U; Department of Cardiology University Hospital, Leipzig University Leipzig Germany., Schurig J; Center for Stroke Research Berlin Charité - Universitätsmedizin Berlin Berlin Germany., Kraft P; Department of Neurology University Hospital Würzburg Würzburg Germany.; Department of Neurology Hospital Main-Spessart Lohr Lohr a. Main Germany., Röther J; Department of Neurology Asklepios Hospital Altona Hamburg Germany., Günther A; Department of Neurology University of Jena Germany., Thomalla G; Department of Neurology University Medical Center Hamburg-Eppendorf Hamburg Germany., Dimitrijeski B; Department of Neurology Vivantes Hospital Neukölln Berlin Germany., Nabavi DG; Department of Neurology Vivantes Hospital Neukölln Berlin Germany., Veltkamp R; Department of Neurology Alfried Krupp Krankenhaus Essen Germany.; Department of Brain Sciences Imperial College London London United Kingdom., Heuschmann PU; Institute of Clinical Epidemiology and Biometry University Würzburg Würzburg Germany.; Clinical Trial Center Würzburg University Hospital Würzburg Würzburg Germany., Haeusler KG; Department of Neurology University Hospital Würzburg Würzburg Germany., Endres M; Center for Stroke Research Berlin Charité - Universitätsmedizin Berlin Berlin Germany.; German Center for Neurodegenerative Diseases (DZNE) Partner Site Berlin Berlin Germany.; German Center for Cardiovascular Research (DZHK) Partner Site Berlin Berlin Germany.; Excellence Cluster NeuroCure Berlin Germany.; Berlin Institute of Health (BIH) Berlin Germany.; Department of Neurology with Experimental Neurology Charité - Universitätsmedizin Berlin Berlin Germany. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2023 Jan 17; Vol. 12 (2), pp. e027149. Date of Electronic Publication: 2023 Jan 11. |
| DOI: |
10.1161/JAHA.122.027149 |
| Abstrakt: |
Background In patients with acute ischemic stroke, little is known regarding the frequency of abnormal ECG findings other than atrial fibrillation and their association with cardiovascular outcomes. We aim to analyze the frequency and type of abnormal ECG findings, subsequent changes in medical treatment, and their association with cardiovascular outcomes in patients with acute ischemic stroke. Methods and Results In the investigator-initiated multicenter MonDAFIS (impact of standardized monitoring for detection of atrial fibrillation in ischemic stroke) study, 3465 patients with acute ischemic stroke or transient ischemic attack and without known atrial fibrillation were randomized 1:1 to receive Holter-ECG for up to 7 days in-hospital with systematic evaluation in a core cardiology laboratory (intervention group) or standard diagnostic care (control group). Outcomes included predefined abnormal ECG findings (eg, pauses, atrial fibrillation, brady-/tachycardias), medical management in the intervention group, and combined vascular end point (recurrent stroke, myocardial infarction, major bleeds, or all-cause death) and mortality at 24 months in both randomization groups. Predefined abnormal ECG findings were detected in 326 of 1693 (19.3%) patients in the intervention group. Twenty of these 326 patients (6.1%) received a pacemaker, and 62 of 326 (19.0%) patients had newly initiated or discontinued β-blocker medication. Discontinuation of β-blockers was associated with a higher death rate in the control group than in the intervention group during 24 months after enrollment (adjusted hazard ratio, 11.0 [95% CI, 2.4-50.4]; P =0.025 for interaction). Conclusions Systematic in-hospital Holter ECG reveals abnormal findings in 1 of 5 patients with acute stroke, and mortality was lower at 24 months in patients with systematic ECG recording in the hospital. Further studies are needed to determine the potential impact of medical management of abnormal ECG findings. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02204267. |
| Databáze: |
MEDLINE |
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