title: Preoperative silent myocardial ischemia. Has it prognostic significance?
abstract: We studied the prognostic significance of preoperative silent myocardial ischemia in patients undergoing coronary artery bypass grafting (CABG). Nonfatal and fatal perioperative myocardial infarction were regarded as prognostically important endpoints. Ninety-five patients (9 women) with stable-effort angina pectoris were studied during their hospital stay in the surgery ward before CABG. Silent ischemia was detected using Holter monitoring; all patients had Holter monitoring 76 +/- 9 h before surgery using Marguette Laser Holter and Cardiodata Prodigy systems. Two-channel electrocardiographic recordings were used which included CM5 and a modified inferior lead. Effort was taken to avoid leads with pathological Q waves and resting ST segment abnormalities. The mean duration of the monitoring was 27.9 +/- 11.3 h. Three patients (3.2%) had angina pectoris during these observations, 1 of them with significant ST depression. Silent ST depression was found in 12 patients (12.6%). Twelve patients (12.6%) had perioperative myocardial infarction. Perioperative myocardial infarction was more common in patients with silent ischemia: 4/12 vs. 8/83; chi 2 = 4.48955, p = 0.0341. Our results suggest that Holter monitoring identifies a group of patients with a higher probability of perioperative myocardial infarction. In the future, it may be possible to study different methods to prevent this surgical complication.
authors.affiliation: János Municipal Hospital III, Internal Department and Cardiology, Budapest, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Jánosi
authors.forename: J
authors.initials: J
authors.lastname: Hankóczy
authors.forename: A
authors.initials: A
authors.lastname: Vértes
authors.forename: A
authors.initials: A
authors.lastname: Kádár
authors.forename: A
authors.initials: A
authors.lastname: Fehér
authors.forename: A
authors.initials: A
authors.lastname: Arvay
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors