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.
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.
Lurati Buse
Giovanna A
GA
Department of Anesthesia, University of Basel, CH-4031 Basel, Switzerland. glurati@uhbs.ch
Seeberger
Manfred D
MD
Schumann
Regina M
RM
Bürgler
David
D
Schwab
Hildebrand S
HS
Bolliger
Daniel
D
Filipovic
Miodrag
M
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
D015415:Biomarkers; D019210:Troponin I