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Postoperative 12‐lead ECG predicts peri‐operative myocardial ischaemia associated with myocardial cell damage
Author(s) -
Böttiger B. W.,
Motsch J.,
Teschendorf P.,
Rehmert G. C.,
Gust R.,
Zorn M.,
Schweizer M.,
Layug E. L.,
SnyderRamos S. A.,
Mangano D. T.,
Martin E.
Publication year - 2004
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2004.03960.x
Subject(s) - medicine , myocardial ischaemia , peri , cardiology , lead (geology) , perioperative , myocardial ischemia , ischemia , electrocardiography , anesthesia , geomorphology , geology
Summary 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.