Postoperative 12-lead ECG predicts peri-operative myocardial ischaemia associated with myocardial cell damage.
Peri-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 peri-operative 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.
Department of Anaesthesiology, University of Heidelber, D-69120 Heidelberg, Germany. bernd_boettiger@med.uni-heidelberg.de
B W
BW
Böttiger
J
J
Motsch
P
P
Teschendorf
G C
GC
Rehmert
R
R
Gust
M
M
Zorn
M
M
Schweizer
E L
EL
Layug
S A
SA
Snyder-Ramos
D T
DT
Mangano
E
E
Martin
D000368:Aged; D015415:Biomarkers / Q000097:blood; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood; D014656:Vascular Surgical Procedures
D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T