title: Postoperative Cardiac Ischemia Detection by Continuous 12-Lead Electrocardiographic Monitoring in Vascular Surgery Patients: A Prospective, Observational Study.
abstract: OBJECTIVE
  Elderly patients undergoing vascular surgery are at major risk for perioperative cardiac complications. The authors investigated continuous electrocardiographic Holter monitoring in a postoperative setting to determine the degree of postoperative ischemic load and its possible associations with perioperative myocardial infarction.
  
  
  METHODS
  A prospective, observational study.
  
  
  METHODS
  One university hospital.
  
  
  METHODS
  The study comprised 51 patients aged 65 years or older undergoing peripheral arterial surgery.
  
  
  METHODS
  Continuous electrocardiographic monitoring with a Holter device was started postoperatively and continued for 72 hours or until discharge. Postural changes were recorded using a 3-axis accelerometer. Standard 12-lead electrocardiography, high-sensitive troponin T measurements, and an inquiry of ischemic symptoms were performed 4 times perioperatively.
  
  
  RESULTS
  The primary outcomes were ischemic load (area under the function of ischemic ST-segment deviation and ischemic time) and perioperative myocardial infarction. During 3,262.7 patient-hours of monitoring, 17 patients (33.3%) experienced 608 transient ischemic events, all denoted by ST-segment depression. Of these 17 patients, 5 experienced perioperative myocardial infarction. The mean ischemic load in all patients was 913.2±2,797.3 µV×minute. Ischemic load predicted perioperative myocardial infarction, with an area under receiver operating characteristics curve (95% confidence interval) of 0.87 (0.75-0.99). Ischemic changes occurred most frequently during hours 24 to 60 of monitoring. Ischemia was asymptomatic in 14 of 17 patients (82.4%).
  
  
  CONCLUSIONS
  Postoperative myocardial ischemia was common in peripheral vascular surgery patients and may progress to perioperative myocardial infarction. Ischemic load was a good predictor of perioperative myocardial infarction. Ambulatory electrocardiographic monitoring solutions for continuous postoperative ischemia detection are warranted in the surgical ward.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Aino
authors.initials: A
authors.lastname: Ollila
authors.affiliation: Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Virolainen
authors.affiliation: GE Healthcare, Helsinki, Finland.
authors.forename: Joonas
authors.initials: J
authors.lastname: Vanhatalo
authors.affiliation: Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Pirkka
authors.initials: P
authors.lastname: Vikatmaa
authors.affiliation: Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Tikkanen
authors.affiliation: Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Maarit
authors.initials: M
authors.lastname: Venermo
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Salmenperä
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: leena.vikatmaa@hus.fi.
authors.forename: Leena
authors.initials: L
authors.lastname: Vikatmaa
mesh_terms: D000368:Aged; D004562:Electrocardiography / Q000379:methods* / Q000639:trends; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods* / Q000639:trends; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000639:trends
keywords: Holter electrocardiography; cardiac ischemia; high-sensitive troponin T; myocardial infarction; perioperative complications; postoperative monitoring; vascular surgery