title: Perioperative ST-segment depression is rare and may not indicate myocardial ischemia in moderate-risk patients undergoing noncardiac surgery.
abstract: OBJECTIVE
  To identify a group of older asymptomatic patients in whom ST-segment changes are common and determine their correlation with occult coronary artery disease.
  
  
  METHODS
  Prospective, cohort study.
  
  
  METHODS
  University hospital, single-center.
  
  
  METHODS
  Patients older than 45 years with at least one risk factor for coronary artery disease but without documented disease undergoing noncardiac, nonvascular surgery.
  
  
  METHODS
  Intraoperative and early postoperative continuous electrocardiographic monitoring, exercise treadmill testing, 24-month telephone follow-up.
  
  
  RESULTS
  A total of 190 patients were studied with a continuous ST-segment monitor, seven of whom demonstrated significant ST-segment changes during the intraoperative or early postoperative period. Three of the seven patients were evaluated by exercise treadmill testing, all of whom had a negative test. Follow-up was complete in 84% of the cohort without ST-segment changes and in all patients with ST-segment changes. One patient with perioperative ST-segment changes died of prostate cancer. None of the other patients showed any symptoms of coronary artery disease on follow-up.
  
  
  CONCLUSIONS
  ST-segment changes are rare during the intraoperative and immediate postoperative period in asymptomatic patients at moderate risk for coronary artery disease. The low incidence of a positive stress test and lack of cardiovascular symptoms on follow-up in patients with perioperative ST-segment changes suggest that caution should be exercised before diagnosing myocardial ischemia and coronary artery disease.
authors.affiliation: Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: M M
authors.initials: MM
authors.lastname: Zielski
authors.forename: S P
authors.initials: SP
authors.lastname: Schulman
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011184:Postoperative Period; D011446:Prospective Studies; D012306:Risk