Original Research
Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans
- Abiodun M. Adeoye
- Okechukwu S. Ogah
- Bruce Ovbiagele
- Rufus Akinyemi
- Vincent Shidali
- Francis Agyekum
- Akinyemi Aje
- Oladimeji Adebayo
- Joshua O. Akinyemi
- Philip Kolo
- Lambert Tetteh Appiah
- Henry Iheonye
- Uwanuruochi Kelechukwu
- Amusa Ganiyu
- Taiwo O. Olunuga
- Onoja Akpa
- Ojo Olakanmi Olagoke
- Fred Stephen Sarfo
- Kolawole Wahab
- Samuel Olowookere
- Adekunle Fakunle
- Albert Akpalu
- Philip B. Adebayo
- Kwadwo Nkromah
- Joseph Yaria
- Philip Ibinaiye
- Godwin Ogbole
- Aridegbe Olumayowa
- Sulaiman Lakoh
- Benedict Calys-Tagoe
- Paul Olowoyo
- Chukwuonye Innocent
- Hemant K. Tiwari
- Donna Arnett
- Osaigbovo Godwin
- Bisi Ayotunde
- Josephine Akpalu
- Okeke Obiora
- Odo Joseph
- Adeleye Omisore
- Carolyn Jenkins
- Daniel Lackland
- Lukman Owolabi
- Suleiman Isah
- Abdu H. Dambatta
- Morenikeji Komolafe
- Andrew Bock-Oruma
- Ezinne Sylvia Melikam
- Lucius Chidiebere Imoh
- Taofiki Sunmonu
- Mulugeta Gebregziabher
- Oluyemisi Olabisi
- Kevin Armstrong
- Ugochukwu U. Onyeonoro
- Emmanuel Sanya
- Atinuke M. Agunloye
- Luqman Ogunjimi
- Oyedunni Arulogun
- Temitope H. Farombi
- Olugbo Obiabo
- Reginald Obiako
- Mayowa Owolabi
- on behalf of the SIREN Team as part of the H3Africa Consortium
Abstract
Background: Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans.
Objectives: The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study.
Methods: We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS).
Results: Patients’ mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02).
Conclusions: About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability.
Highlights
- 4 in 5 acute stroke patients in this African cohort had at least 1 ECG abnormality.
- Atrial fibrillation was rare in the cohort, occurring in <5% overall.
- Atrial fibrillation was more common in female stroke patients.
- Presence of any atrial enlargement was the only independent ECG predictor of death or disability.