Prognostic significance of ST-segment depression on continuous electrocardiography in patients with acute ischemic neurologic events.

Patients with a history of ischemic stroke or transient ischemic attack (TIA) are at significant risk of cardiac death. This study reports the prognostic significance of ST-segment depression and ventricular tachycardia on continuous electrocardiography in 48 consecutive patients hospitalized with an acute ischemic stroke or TIA. Thirty-one percent of patients had episodes of asymptomatic ST-segment depression and 6% had transient ventricular tachycardia on continuous electrocardiographic monitoring. At a mean follow-up of 13 months, 19% had experienced a cardiac outcome, and 19% met criteria for a neurologic outcome. Cardiac and neurologic outcomes, including death, were not significantly different in patients with and without ST-segment depression on continuous electrocardiography. Cardiac outcomes occurred in 13% of patients with ST-segment depression and in 21% of patient without ST-segment depression (p = 0.52). However, ventricular tachycardia was associated with a higher rate of cardiac death (33% vs. 2%, p < 0.01). Only 27% of patients subsequently found to have coronary artery disease had ST-segment depression by continuous electrocardiography. In contrast to patients with coronary artery disease, ST-segment depression on continuous electrocardiography is not associated with poorer outcome among patients with acute ischemic stroke or TIA.