Key result
ST-segment depression of ≥0.1 mV during preoperative exercise electrocardiography was an independent predictor of perioperative adverse cardiac events (OR 5.2; 95% CI 1.5-18.5; P=0.01).
Why the study?
Does electrocardiographic exercise stress testing predict perioperative cardiac events in intermediate-risk patients undergoing noncardiac surgery?
Cohort (n=185)
Does electrocardiographic exercise stress testing predict perioperative cardiac events in intermediate-risk patients undergoing noncardiac surgery?
Answers are grounded in this paper and cite their sources.
Exercise electrocardiography showing ST-segment depression ≥0.1 mV is an independent predictor of perioperative cardiac complications in intermediate-risk patients undergoing noncardiac surgery.
BACKGROUND: The value of exercise electrocardiography in the prediction of perioperative cardiac risk has yet to be defined. This study was performed to determine the predictive value of exercise electrocardiography as compared with clinical parameters and resting electrocardiography. METHODS: A total of 204 patients at intermediate risk for cardiac complications prospectively underwent exercise electrocardiography before noncardiac surgery. Of these, 185 were included in the final evaluation. All patients underwent follow-up evaluation postoperatively by Holter monitoring for 2 days, daily 12-lead electrocardiogram, and creatine kinase, creatine kinase MB, and troponin-T measurements for 5 days. Cardiac events were defined as cardiac death, myocardial infarction, minor myocardial cell injury, unstable angina pectoris, congestive heart failure, and ventricular tachyarrhythmia. Potential risk factors for an adverse event were identified by univariate and multivariate logistic regression analysis. RESULTS: Perioperative cardiac events were observed in 16 patients. There were 6 cases of myocardial infarction and 10 cases of myocardial cell injury. The multivariate correlates of adverse cardiac events were definite coronary artery disease (odds ratio, 8.8; 95% confidence interval [CI], 1.1--73.1; P = 0.04), major surgery (odds ratio, 4.7; 95% CI, 1.3--16.3; P = 0.02), reduced left ventricular performance (odds ratio, 2.0; 95% CI, 1.1--3.8; P = 0.03), and ST-segment depression of 0.1 mV or more in the exercise electrocardiogram (odds ratio, 5.2; 95% CI, 1.5--18.5; P = 0.01). A combination of clinical variables and exercise electrocardiography improved preoperative risk stratification. CONCLUSIONS: This prospective study shows that a ST-segment depression of 0.1 mV or more in the exercise electrocardiogram is an independent predictor of perioperative cardiac complications.
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Gauss et al. (2001) conducted a cohort in Intermediate risk for cardiac complications undergoing noncardiac surgery (n=185). ST-segment depression of ≥0.1 mV in the exercise electrocardiogram vs. Absence of ST-segment depression of ≥0.1 mV was evaluated on Perioperative cardiac events (cardiac death, myocardial infarction, minor myocardial cell injury, unstable angina pectoris, congestive heart failure, and ventricular tachyarrhythmia) (OR 5.2, 95% CI 1.5-18.5, p=0.01). ST-segment depression of ≥0.1 mV during preoperative exercise electrocardiography was an independent predictor of perioperative adverse cardiac events (OR 5.2; 95% CI 1.5-18.5; P=0.01).
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