预测急性冠状动脉综合征后缺血性卒中的心电图标志物。

Electrocardiogram markers predicting ischemic stroke after acute coronary syndrome.

作者信息

Hurskainen Matilda, Tynkkynen Juho, Lyytikäinen Leo-Pekka, Lehtimäki Terho, Nikus Kjell, Hernesniemi Jussi

机构信息

Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Centre of Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.

出版信息

Int J Cardiol Cardiovasc Risk Prev. 2025 Aug 22;27:200500. doi: 10.1016/j.ijcrp.2025.200500. eCollection 2025 Dec.

DOI:10.1016/j.ijcrp.2025.200500

PMID:40917079

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12410464/

Abstract

BACKGROUND

Patients with coronary artery disease (CAD) have increased risk of ischemic stroke (IS). Our aim was to screen for significant electrocardiogram (ECG) features for IS risk in patients treated for acute coronary syndrome (ACS).

METHODS

This retrospective registry study is based on 7760 ACS patients treated in Tays Heart Hospital (2007-2018) with follow-up for incident IS until December 31st 2020. ECGs recorded during ACSs were analysed by the Marquette™ 12SL™ ECG Analysis Program version 24. Preliminary screening for ECG features was conducted using age- and sex adjusted Cox regression analysis and corrected by multiple testing (Bonferroni method). Highly correlated variables were excluded from the final age-, sex- and atrial fibrillation (AF)/atrial flutter (AFL) adjusted Cox regression and subdistribution hazard (SDH) multivariable analyses.

RESULTS

From 7760 patients, 489 (6.3 %) suffered IS during a median follow-up of 5.7 years (IQR 3.1-8.8). In the final multivariable model, the main risk factors were premature ventricular complexes (PVCs) or aberrantly conducted complexes in AF/AFL (SDH, 2.01 [1.22-3.31]), left ventricular (LV) hypertrophy (LVH) by Sokolow-Lyon criteria (SDH, 1.52 [1.12-2.06]), S wave amplitude in lead V4 (SDH, 1.13 [1.05-1.21]) and negative P wave peak time in lead V2 (SDH, 1.12 [1.02-1.23]). T wave amplitude in lead V6 (SDH, 0.78 [0.69-0.88]) and T wave duration in lead aVL (SDH, 0.85 [0.78-0.92]) showed an inverse association with IS risk. The continuous variables correspond to 1 SD.

CONCLUSIONS

ECG markers demonstrating LV dysfunction, LVH and atriopathy associate with IS risk after ACS, although external validation is still required.

摘要

背景

冠心病（CAD）患者发生缺血性卒中（IS）的风险增加。我们的目的是筛查急性冠状动脉综合征（ACS）治疗患者中与IS风险相关的显著心电图（ECG）特征。

方法

这项回顾性登记研究基于泰斯心脏医院（2007 - 2018年）治疗的7760例ACS患者，随访至2020年12月31日的IS事件。ACS期间记录的心电图由Marquette™ 12SL™心电图分析程序版本24进行分析。使用年龄和性别调整的Cox回归分析对心电图特征进行初步筛查，并通过多重检验（Bonferroni法）进行校正。在最终的年龄、性别和心房颤动（AF）/心房扑动（AFL）调整的Cox回归和亚分布风险（SDH）多变量分析中排除高度相关的变量。

结果

7760例患者中，489例（6.3%）在中位随访5.7年（IQR 3.1 - 8.8）期间发生IS。在最终的多变量模型中，主要危险因素为室性早搏（PVCs）或AF/AFL中的异常传导复合波（SDH，2.01 [1.22 - 3.31]）、根据Sokolow - Lyon标准诊断的左心室（LV）肥厚（LVH）（SDH，1.52 [1.12 - 2.06]）、V4导联S波振幅（SDH，1.13 [1.05 - 1.21]）和V2导联P波负向峰值时间（SDH，1.12 [1.02 - 1.23]）。V6导联T波振幅（SDH，0.78 [0.69 - 0.88]）和aVL导联T波持续时间（SDH，0.85 [0.78 - 0.92]）与IS风险呈负相关。连续变量对应1个标准差。