<b>Electrocardiogram as a Predictor of Outcome in Cerebral Vascular Accident Patients: A Cross-Sectional Study in Sheikh Zayed Hospital Rahim Yar Khan</b>

Background: Cerebrovascular accidents (CVAs) are a leading cause of morbidity and mortality worldwide, particularly in low- and middle-income countries. Electrocardiographic (ECG) abnormalities are frequently observed in stroke patients and may reflect neurocardiogenic disturbances or underlying cardiac comorbidities. Their potential utility as prognostic markers remains underexplored in resource-limited emergency settings. Objective: To determine the prognostic significance of ECG abnormalities in predicting in-hospital outcomes among patients presenting with acute CVA. Methods: A cross-sectional observational study was conducted at the emergency department of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan, from July to December 2023. A total of 202 adult patients clinically suspected of CVA underwent baseline ECG evaluation on admission. Specific ECG abnormalities—including P wave changes, QT prolongation, T wave inversion, bundle branch blocks, and axis deviations—were recorded. Outcomes were categorized as discharge, ICU admission, or in-hospital death. Associations between ECG findings and outcomes were analyzed using chi-square tests and odds ratios, with p<0.05 considered significant. Results: Among 202 patients (mean age 58.65 ± 14.14 years), 54 (26.7%) died. QT prolongation (100% mortality, p=0.004), P wave abnormality (66.7% mortality, p=0.006), and T wave inversion (52.9% mortality, p=0.038) were significantly associated with in-hospital death. Mortality also increased with age >65 and cumulative ECG risk features. Conclusion: Early ECG abnormalities—especially QT prolongation, P wave changes, and T wave inversion—are significant predictors of mortality in acute stroke and should be incorporated into early risk stratification protocols in emergency care.