Background: ECG is a useful tool in monitoring vital functions in patients wi th acute stroke; however, fairly little evidence is available concerning the pre valence and the prognostic impact of ECG findings in patients with acute cerebra l infarction and acute intracerebral haemorrhage (ICH). Methods: This analysis w as based on data from 692 patients with acute cerebral infarction, 155 patients with intracerebral haemorrhage (ICH), and 223 patients with transient ischaemic attack (TIA), who were admitted to hospital within 6 h of symptom onset. A 12 le ad ECG was obtained on admission, and the patient was on telemetry for the first 12- 24 h of hospitalisation. Results: ECG abnormalities were observed in 60% of patients with cerebral infarction, 50% of patients with ICH, and 44% of patients with TIA. In multivariate analyses 3- month mortality in patients with ischaemic stroke was predicted by atrial fibrillation OR 2.0 (95% CI 1.3- 3. 1), atrio- ventricular block OR 1.9 (95% CI 1.2- 3.9), ST- elevation OR (2. 8, 95% CI 1.3- 6.3), ST- depression OR 2.5 (95% CI 1.5- 4.3), and inverte d T- waves OR 2.7 (95% CI 1.6- 4.6). This was independent of stroke severity , pre- stroke disability and age. In patients with ICH, sinus tachycardia OR 4. 8 (95% CI 1.7- 14.0), ST- depression OR 5.2 (95% CI 1.1- 24.9), and inver ted T- wave 5.2 (95% CI 1.2- 22.5) predicted poor outcome. None of the chang es reached significance in patients with TIA. In patients with severe cerebral i nfarction or ICH, heart rate did not decrease within the first 12 h after admiss ion, which was the case in patients with mild to moderate stroke. Rapid heart ra te predicted 3- month mortality in multivariate testing OR 1.7 (95% CI 1.02- 2.7). Conclusions: ECG abnormalities are frequent in acute stroke and may predi ct 3- month mortality. Background: ECG is a useful tool in monitoring vital functions in patients wi th acute stroke; however, fairly little evidence is available about the pre valence and the prognostic impact of ECG findings in patients with acute cerebra l infarction and acute intracerebral haemorrhage (ICH) . Methods: This analysis w based on data from 692 patients with acute cerebral infarction, 155 patients with intracerebral haemorrhage (ICH), and 223 patients with transient ischaemic attack (TIA), who were admitted to hospital within 6 h of symptom onset. A 12 le ad ECG was obtained on admission, and the patient was on telemetry for the first 12- 24 h of hospitalization. Results: ECG abnormalities were observed in 60% of patients with cerebral infarction, 50% of patients with ICH, and 44 % of patients with TIA. In multivariate analyzes 3- month mortality in patients with ischaemic stroke was predicted by atrial fibrillation OR 2.0 (95% CI 1.3-3.1), atrio-ventricular block OR 1.9 (95% CI 1.2- 3.9), ST-elevation OR (2.8, 95% CI 1.3- 6.3), ST depression 2 2.5 (95% CI 1.5-4.3) In patients with ICH, sinus tachycardia OR 4.8 (95% CI 1.7-14.0), ST-depression OR 5.2 (95% CI 1.1-24.9), and Inver ted T- wave 5.2 (95% CI 1.2- 22.5) predicted poor outcome. None of the subjects escaped significance in patients with TIA. In patients with severe cerebral i nfarction or ICH, heart rate did not decrease within the first 12 h After admiss ion, which was the case in patients with mild to moderate stroke. Rapid heart ra te predicted 3- month mortality in multivariate testing OR 1.7 (95% CI 1.02- 2.7). Conclusions: ECG abnormalities are frequent in acute stroke and may predi ct 3- month mortality.