title: Impact of the American College of Cardiology/American Heart Association guidelines for interpretability of continuous electrocardiography on the association of silent ischemia with troponin release after major noncardiac surgery.
abstract: BACKGROUND
  Preexisting electrocardiographic abnormalities may limit accuracy of continuous electrocardiography (cECG) for ischemia determination. The American College of Cardiology/American Heart Association published criteria for the exclusion of unsuitable cECG curves from ST-segment interpretation. These criteria consider medication and 12-lead ECG findings (medication- and 12-lead ECG-based criteria) and cECG lead characteristics (cECG-based criteria).
  
  
  METHODS
  We recorded cECG in 300 patients undergoing major noncardiac surgery. We determined postoperative troponin and 12-month outcome. We compared the associations of cECG-detected ischemia with troponin and 12-month outcome with and without adherence to the criteria.
  
  
  RESULTS
  Adherence to the medication- and 12-lead ECG-based criteria enhanced the association between troponin and perioperative ischemia in CM5 (odds ratio, 3.74; 95% confidence interval, 1.88-7.44) and 7.03 (2.67-18.49), respectively; P = .049). Similarly, the association between ischemia in CM5 and 12-month outcome tended to increase (P = .081).
  
  
  CONCLUSIONS
  Applying the guideline criteria for the interpretation of cECG enhanced cECG diagnostic value in surgical patients.
authors: Department of Anesthesia, University of Basel, CH-4031 Basel, Switzerland. glurati@uhbs.ch
authors: Giovanna A
authors: GA
authors: Lurati Buse
authors: Manfred D
authors: MD
authors: Seeberger
authors: Regina M
authors: RM
authors: Schumann
authors: David
authors: D
authors: Bürgler
authors: Hildebrand S
authors: HS
authors: Schwab
authors: Daniel
authors: D
authors: Bolliger
authors: Miodrag
authors: M
authors: Filipovic
mesh_terms: D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography / Q000592:standards*; D006801:Humans; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*; D014481:United States
chemical_list: D015415:Biomarkers; D019210:Troponin I