Early postoperative myocardial morbidity in patients with coronary artery disease undergoing major non-cardiac surgery: correlation with perioperative ischaemia

Postoperative myocardial damage in patients with coronary artery disease undergoing major non cardiac surgery

“…The results of 24 hr Holter monitoring and the non-invasive blood pressure monitoring presented in a subsequent paper may help gain an understanding of the mechanism of such damage. 9 The numbers in this study are small compared with the series of Goldman et al 7 and Tarhan et al 5 The majority of the patients in this group underwent vascular surgery and these patients could represent a sub-group at one extreme of the population of patients with concurrent coronary artery disease, presenting for major surgery. The Goldman risk index has been shown to underestimate the incidence of further myocardial damage in patients having vascular surgery.…”

Outcome after Elective Infrarenal Aortic Aneurysm Surgery

“…Sinus tachycardia, which we defined as a heart rate of Ͼ 90 bpm, was the most frequent complication and was considered an indication for active intervention by continuous intravenous ␤-blockers, after other causes of postoperative tachycardia (e.g., hypoxemia, pain, and electrolyte disturbances) had been excluded. We consider tachycardia a significant complication because it has been shown that during the postoperative period an elevated heart rate may result in significant ST segment changes of ischemia on Holter monitoring, even without complaints of chest pain [21,22]. Our patients are monitored for at least 24 hours following surgery, and all deviations from treatment goals are treated early and aggressively.…”

Detection of perioperative myocardial ischaemia

“…Studies using ambulatory ECG have shown that the incidence of myocardial ischaemia in patients with CAD, undergoing either cardiac or non-cardiac surgery, increase after operation from that found in the preoperative and peroperative periods [53,70,72,73,82,102,112]. Mangano and colleagues found a two-fold increase in the incidence of ischaemia after operation compared with the periods before and during operation [72].…”

“…Several of these studies indicate that postoperative myocardial ischaemia is a more important indicator of adverse cardiac outcome than either preoperative or intraoperative ischaemia [72,73,82,102]. Indeed, Mangano and colleagues [72] showed a nine-fold increase in the risk of a postoperative cardiac event in patients who had ambulatory ECG evidence of postoperative myocardial ischaemia.…”

“…However, the use in the early postoperative period of on-line, computerized ST-segment monitoring which can be programmed to alert staff to the presence of significant deviations in ST-segment and provide immediate print-outs of such episodes, allows ischaemic changes to be promptly recognized and treated [16,26]. An increase in the number of leads monitored improves the detection of postoperative myocardial ischaemia [102].…”