Arrhythmias & electrophysiologySecondary analysis
Prolonged QT interval and risk of recurrent stroke in the Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) trial
- secondary analysis
- randomised trial (ARCADIA)
- North America, 2018 to 2023
- multivariable Cox proportional hazards models
Authors' conclusion
Among patients with recent cryptogenic stroke and atrial cardiopathy, QTc prolongation was associated with a reduced risk of recurrent stroke. These findings contrast with the association observed between QTc prolongation and first stroke in the general population, which may reflect the unique characteristics of this selected population. If confirmed in broader populations, these findings suggest that electrocardiographic markers such as QTc may have distinct implications for risk stratification in terms of first versus recurrent stroke.
Study context
- Population
- Patients with cryptogenic stroke and atrial cardiopathy randomised to apixaban versus aspirin, excluding those with missing ECG data and prolonged QRS (≥120 ms)included patients, 139 (15.8%) had a prolonged cohort-specific QTc
- Participants
- 881 patients
- Comparison
- association between QTc and recurrent stroke of any type
- prolonged QTcn = 139
Primary result
As reported in the abstract
patients with recurrent strokes
62
crude rate
7.0%
annualised rate
3.9% per year
Further findings
| Outcome | Estimate | |
|---|---|---|
| Recurrent stroke, by cohort-specific QTc — cohort-specific QTc · decreased risk with prolongation · after multivariable adjustment | HR 0.72 per SD (95% CI 0.54–0.95) | |
| Recurrent stroke, by cohort-specific QTc — prolonged QTc vs normal QTc · decreased risk with prolonged QTc · after multivariable adjustment | HR 0.16 (95% CI 0.04–0.64) | |
| 0.050.21520Hazard ratio (log scale) |
Sensitivity analyses
- Findings consistent across methods of QT interval correction
- Accounting for the timing of baseline ECG, QRS duration, incident atrial fibrillation and the competing risk of death did not change the results
Original publication
Summarised from the published abstract; every number is checked against it