Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group.
OBJECTIVE
To identify predictors of postoperative myocardial ischemia in patients scheduled to undergo major noncardiac surgery.


METHODS
Historical, clinical, laboratory, and physiological data were obtained prospectively before and during surgery to identify potential univariate predictors of postoperative myocardial ischemia, which then were entered into multivariate logistic models. Continuous two-lead electrocardiograms before, during, and after surgery were used to identify episodes of myocardial ischemia.


METHODS
Department of Veterans Affairs tertiary care hospital.


METHODS
A consecutive sample of 474 men at high risk for or with coronary artery disease who were scheduled to undergo major noncardiac surgery (95% compliance rate).


METHODS
Significant variables identified by multivariate logistic models that are associated with postoperative myocardial ischemia.


RESULTS
Five major preoperative predictors of postoperative myocardial ischemia were identified: (1) left ventricular hypertrophy by electrocardiogram; (2) history of hypertension; (3) diabetes mellitus; (4) definite coronary artery disease; and (5) use of digoxin. The risk of postoperative myocardial ischemia increased progressively with the number of predictors present: in 22% of patients with no predictors, in 31% with one predictor, in 46% with two predictors, in 70% with three predictors, and in 77% with four predictors.


CONCLUSIONS
Patients subgroups who are at high risk for developing postoperative myocardial ischemia and who might benefit the most from intensive Holter monitoring in the postoperative period now can be identified preoperatively.
Hollenberg
M
M
Department of Medicine, University of California, San Francisco.
Mangano
D T
DT
Browner
W S
WS
London
M J
MJ
Tubau
J F
JF
Tateo
I M
IM
D000368:Aged; D006332:Cardiomegaly / Q000150:complications; D003327:Coronary Disease / Q000209:etiology* / Q000503:physiopathology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D015716:Electrocardiography, Ambulatory; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors