Prognostic importance of automated ST-segment monitoring after coronary artery bypass graft surgery.
BACKGROUND
Automated ST-segment monitors are widely used in cardiac surgery units. The purpose of this study was to determine if cardiac morbidity and mortality, after CABG surgery, are predicted by ECG ST-segment changes on automated monitors.


METHODS
One hundred patients, who underwent CABG, were included in this prospective study. ST-segment deviations were recorded by an automated ST monitor, in the ICU, for 24 h after surgery. A reversible ST depression of more than 0.1 mV or a ST elevation of more than 0.2 mV and for at least 1 min were considered as significant episodes. Adverse cardiac outcomes were defined as: myocardial infarction (MI), severe left ventricular failure, ventricular fibrillation (VF) and cardiac-related death.


RESULTS
Sixty patients (group 1) presented significant episodes of ST deviation (6+/-5 episodes per patient). Forty patients (group 2) were free from ST changes. Eight patients from group 1 had postoperative adverse cardiac outcomes: 5 MI, 2 VF and 1 cardiac-related death. Patients from group 2 were all free from adverse cardiac outcomes. Automated ST-segment analysis during the first 24 h had a positive predictive value of 13% and a negative predictive value of 100%.


CONCLUSIONS
Automated ST analysis is a non-invasive, sensitive and very easy-to-use monitoring system to screen patients who may develop myocardial ischemia and cardiac complications after CABG surgery.
Yazigi
A
A
Department of Anesthesiology and Intensive Care, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
Richa
F
F
Gebara
S
S
Haddad
F
F
Hayek
G
G
Antakly
M C
MC
D001331:Automation; D002303:Cardiac Output, Low / Q000175:diagnosis; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003422:Critical Care; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000517:prevention & control; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis; D014693:Ventricular Fibrillation / Q000175:diagnosis