Long-term prognostic value of the preoperative 12-lead electrocardiogram before major noncardiac surgery in coronary artery disease.
BACKGROUND
Knowledge of the prognostic information of preoperative 12-lead electrocardiogram (ECG) recordings in patients with coronary artery disease (CAD) undergoing noncardiac surgery is limited.


METHODS
The prognostic information derived from the preoperative ECGs of 172 CAD patients undergoing major noncardiac surgery was analyzed to determine its predictive value for long-term outcome. Primary end point was all-cause mortality; secondary end point was major adverse cardiac events (MACE) at 2 years.


RESULTS
Prevalence of ECG abnormalities was 53% for T-wave alterations; 46% for Q waves; 38% for ST deviations; and, depending on the criterion used, 2% to 19% for left ventricular hypertrophy. During follow-up, 40 (23%) patients died and 31 (18%) had MACE. After adjustment for clinical baseline findings, including current medication with beta-blockers, ST depressions (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.9-10.5) and faster heart rate (HR) (OR 1.6, 95% CI 1.1-2.4, per 10 beats per minute [bpm] increase) were independent predictors of all-cause mortality. Faster HR (OR 1.7, 95% CI 1.1-2.6, per 10-bpm increase) was also an independent predictor of MACE. The predictive value of ECG variables did not change after adjustment for occurence of perioperative ischemia.


CONCLUSIONS
In CAD patients, the preoperative ECG contains important prognostic information and is predictive of long-term outcome independent of clinical findings and perioperative ischemia.
Jeger
Raban V
RV
Division of Cardiology, University Hospital, Basel, Switzerland.
Probst
Cecilia
C
Arsenic
Ruza
R
Lippuner
Thomas
T
Pfisterer
Matthias E
ME
Seeberger
Manfred D
MD
Filipovic
Miodrag
M
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology*; D004562:Electrocardiography; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology; D015588:Observer Variation; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D013514:Surgical Procedures, Operative / Q000401:mortality*