Postoperative 12‐lead ECG predicts peri‐operative myocardial ischaemia associated with myocardial cell damage

Abstract

SummaryPeri-operative myocardial ischaemia is the single most important risk factor for an adverse cardiac outcome after non-cardiac surgery. The present study examines whether intermittent 12-lead ECG recordings can be used as an early warning tool to identify patients suffering from perioperative myocardial ischaemia and subsequent myocardial cell damage. Fifty-five vascular surgery patients at risk for or with a history of coronary artery disease were monitored for peri-operative myocardial ischaemia using intermittent 12-lead ECG recordings taken pre-operatively and at 15 min, 20 h, 48 h, 72 h and 84 h postoperatively. The effectiveness of the 12-lead ECG was gauged by examining concordance with continuous 3-channel Holter monitoring and capturing peri-operative myocardial ischaemia by serial analyses of creatine kinase myocardial band isoenzyme and cardiac troponin T and I. The incidence of peri-operative myocardial ischaemia detected by 12-lead ECG was 44% and was identifiable in most patients (88%) 15 min after surgery. The incidence of peri-operative myocardial ischaemia detected by continuous monitoring was 53%, with the most severe episodes occurring intra-operatively and during emergence from anaesthesia. The concordance of the 12-lead method with continuous monitoring was 72%. The concordance of creatine kinase myocardial band isoenzyme activity with the 12-lead method was 71% and with Holter monitoring 57%. The concordance of mass concentration of creatine kinase myocardial band with 12-lead ECG recordings was 75%, and the corresponding value for Holter monitoring was 68%. The concordance of cardiac troponin T and I levels with the 12-lead method was 85% and 87%, respectively, and concordance with Holter monitoring was 72% and 66%, respectively. The postoperative 12-lead ECG identified peri-operative myocardial ischaemia associated with subsequent myocardial cell damage in most patients undergoing vascular surgery.

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…4 In fact, the RR of an adverse event associated with ECG changes was higher in the lower-risk group, increasing the events more than 4-fold compared with 2-fold in the high-risk subset. Bottiger and colleagues 547 investigated the value of 12-lead ECGs obtained 15 minutes, 20 hours, 48 hours, 72 hours, and 84 hours after operation in 55 patients. For study entry, patients had operations that required more than 1 hour of anesthesia and a history of CAD or 2 cardiovascular disease risk factors.…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…In fact, the RR of an adverse event associated with ECG changes was higher in the lower-risk group, increasing the events more than 4-fold compared with 2-fold in the high-risk subset. Bottiger et al (558) investigated the value of 12-lead ECGs obtained 15 minutes, 20 hours, 48 hours, 72 hours, and 84 hours after operation in 55 patients. For study entry, patients had operations that required more than 1 hour of anesthesia and a history of CAD or 2 cardiovascular disease risk factors.…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…4 In fact, the RR of an adverse event associated with ECG changes was higher in the lower-risk group, increasing the events more than 4-fold compared with 2-fold in the high-risk subset. Bottiger et al 558 were noted in the first postoperative evaluation. Moreover, early ECG changes were concordant with cardiac biomarker evidence of myocardial damage.…”