TY - JOUR
T1 - Perioperative ischemia and cardiac complications in major vascular surgery
T2 - Importance of the preoperative twelve-lead electrocardiogram
AU - Landesberg, G.
AU - Einav, S.
AU - Christopherson, R.
AU - Beattie, C.
AU - Berlatzky, Y.
AU - Rosenfeld, B.
AU - Eidelman, L. A.
AU - Norris, E.
AU - Anner, H.
AU - Mosseri, M.
AU - Cotev, S.
AU - Luria, M. H.
N1 - Funding Information:
Supported by funding from the Hebrew University–Hadassah Hospital Mutual Fund (1992-94) and National Institutes of Health Grant GM 38177.
PY - 1997
Y1 - 1997
N2 - Purpose: To investigate the associations between specific preoperative 12-lead electrocardiogram (ECG) abnormalities, perioperative ischemia, and postoperative myocardial infarction or cardiac death in major vascular surgery. Methods: Two prospective studies on perioperative myocardial ischemia performed in two tertiary university hospitals were combined to include 405 patients. All preoperative ECGs were analyzed according to the Sokolow-Lyon criteria for left ventricular hypertrophy by investigators who were blinded to the patients' perioperative clinical course. Perioperative myocardial ischemia was detected by continuous ECG recording, and postoperative cardiac complications included myocardial infarction and cardiac death. Results: A total of 19 postoperative cardiac complications occurred (two cardiac deaths and 17 myocardial infarctions). Voltage criteria for left ventricular hypertrophy (78 patients, 19%) and ST segment depression greater than 0.5 mm (98 patients, 24.2%) on preoperative ECGs were both significantly associated with postoperative myocardial infarction or cardiac death (odds ratio, 4.2 and 4.7; p = 0.001 and 0.0005, respectively) and with longer intraoperative and postoperative myocardial ischemia. In each of the two study groups, a preoperative ECG abnormality that involved voltage criteria, ST segment depression, or both (134 patients, 33.1%l was more predictive of postoperative cardiac complications than any other preoperative clinical variable, including a history of myocardial infarction or angina pectoris, diabetes mellitus, pathologic Q-wave by ECG, or preoperative myocardial ischemia. The combined duration of intraoperative and postoperative ischemia and the preoperative EGG with either voltage criteria or ST segment depression were the only independent factors associated with adverse cardiac events by multivariate analysis (p ≤ 0.0001 and p = 0.02, respectively). Conclusion: Left ventricular hypertrophy and ST segment depression on preoperative 12-lead ECGs are important markers of increased risk for myocardial infarction or cardiac death after major vascular surgery.
AB - Purpose: To investigate the associations between specific preoperative 12-lead electrocardiogram (ECG) abnormalities, perioperative ischemia, and postoperative myocardial infarction or cardiac death in major vascular surgery. Methods: Two prospective studies on perioperative myocardial ischemia performed in two tertiary university hospitals were combined to include 405 patients. All preoperative ECGs were analyzed according to the Sokolow-Lyon criteria for left ventricular hypertrophy by investigators who were blinded to the patients' perioperative clinical course. Perioperative myocardial ischemia was detected by continuous ECG recording, and postoperative cardiac complications included myocardial infarction and cardiac death. Results: A total of 19 postoperative cardiac complications occurred (two cardiac deaths and 17 myocardial infarctions). Voltage criteria for left ventricular hypertrophy (78 patients, 19%) and ST segment depression greater than 0.5 mm (98 patients, 24.2%) on preoperative ECGs were both significantly associated with postoperative myocardial infarction or cardiac death (odds ratio, 4.2 and 4.7; p = 0.001 and 0.0005, respectively) and with longer intraoperative and postoperative myocardial ischemia. In each of the two study groups, a preoperative ECG abnormality that involved voltage criteria, ST segment depression, or both (134 patients, 33.1%l was more predictive of postoperative cardiac complications than any other preoperative clinical variable, including a history of myocardial infarction or angina pectoris, diabetes mellitus, pathologic Q-wave by ECG, or preoperative myocardial ischemia. The combined duration of intraoperative and postoperative ischemia and the preoperative EGG with either voltage criteria or ST segment depression were the only independent factors associated with adverse cardiac events by multivariate analysis (p ≤ 0.0001 and p = 0.02, respectively). Conclusion: Left ventricular hypertrophy and ST segment depression on preoperative 12-lead ECGs are important markers of increased risk for myocardial infarction or cardiac death after major vascular surgery.
UR - http://www.scopus.com/inward/record.url?scp=0030829869&partnerID=8YFLogxK
U2 - 10.1016/S0741-5214(97)70054-5
DO - 10.1016/S0741-5214(97)70054-5
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C2 - 9357456
AN - SCOPUS:0030829869
SN - 0741-5214
VL - 26
SP - 570
EP - 578
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 4
ER -