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Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery
Affiliations- Department of Vascular Surgery and Angiology, St. John Grande Hospital, Kraków, Poland
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
- Diamond Clinic, Kraków, Poland
- Maksymilian Kotynia Individual Medical Practice, Kraków, Poland
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Abstract
Background: The current European guidelines recommend that preoperative electrocardiogram (ECG) should be performed routinely in patients scheduled for high-risk surgery. However, the evidence regarding ECG as a predictor of perioperative cardiac complications is weak.
Aim: To evaluate association of preoperative ECG with short- and long-term outcomes in patients undergoing high-risk vascular procedures.
Methods: This was a substudy of the international Vascular events In noncardiac Surgery patIents cohort evaluatioN (VISION) Study and included consecutive patients undergoing vascular procedures in a single tertiary center. In each patient a preoperative 12-lead ECG was evaluated in accordance with the Polish Cardiac Society recommendation by two experienced clinicians. We performed routine perioperative troponin monitoring in five time points (one preoperative and four postoperative measurements) to evaluate whether preoperative ECG abnormalities are associated with myocardial injury after noncardiac surgery (MINS) and 1-year major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction and stroke.
Results: Study group comprised 348 patients, 80.5% of whom were male and the median age (interquartile range [IQR]) was 65 (59–72) years. The incidence of MINS and 1-year MACE was 18.7% and 14.4%, respectively. A multivariable analysis showed that none of the predefined ECG abnormalities (ST depression, left axis deviation, atrial fibrillation and bundle branch block) was associated with the incidence of MINS or 1-year MACE.
Conclusion: This study confirmed that preoperative ECG abnormalities are frequent in patients undergoing high-risk vascular surgery. However, we did not find evidence supporting relation between preoperative ECG abnormalities and postoperative adverse cardiac outcomes in high risk patients.
Abstract
Background: The current European guidelines recommend that preoperative electrocardiogram (ECG) should be performed routinely in patients scheduled for high-risk surgery. However, the evidence regarding ECG as a predictor of perioperative cardiac complications is weak.
Aim: To evaluate association of preoperative ECG with short- and long-term outcomes in patients undergoing high-risk vascular procedures.
Methods: This was a substudy of the international Vascular events In noncardiac Surgery patIents cohort evaluatioN (VISION) Study and included consecutive patients undergoing vascular procedures in a single tertiary center. In each patient a preoperative 12-lead ECG was evaluated in accordance with the Polish Cardiac Society recommendation by two experienced clinicians. We performed routine perioperative troponin monitoring in five time points (one preoperative and four postoperative measurements) to evaluate whether preoperative ECG abnormalities are associated with myocardial injury after noncardiac surgery (MINS) and 1-year major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction and stroke.
Results: Study group comprised 348 patients, 80.5% of whom were male and the median age (interquartile range [IQR]) was 65 (59–72) years. The incidence of MINS and 1-year MACE was 18.7% and 14.4%, respectively. A multivariable analysis showed that none of the predefined ECG abnormalities (ST depression, left axis deviation, atrial fibrillation and bundle branch block) was associated with the incidence of MINS or 1-year MACE.
Conclusion: This study confirmed that preoperative ECG abnormalities are frequent in patients undergoing high-risk vascular surgery. However, we did not find evidence supporting relation between preoperative ECG abnormalities and postoperative adverse cardiac outcomes in high risk patients.
Keywords
major adverse cardiovascular events, myocardial injury after noncardiac surgery, preoperative electrocardiography
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About this articleTitle
Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery
Journal
Kardiologia Polska (Polish Heart Journal)
Issue
Article type
Original article
Published online
2022-03-28
Page views
99
Article views/downloads
34
DOI
10.33963/KP.a2022.0085
Pubmed
Keywords
major adverse cardiovascular events
myocardial injury after noncardiac surgery
preoperative electrocardiography
Authors
Dorota Studzińska
Kamil Polok
Barbara Rewerska
Maksymilian Kotynia
Piotr Rewerski
Anna Włudarczyk
Jacek Górka
Mateusz Kózka
Wojciech Szczeklik
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