Value of new ST-segment/T-wave changes for prediction of major adverse cardiac events after vascular surgery: a meta-analysis

INTRODUCTION: The aim of this review is to examine current evidence on value of new ST-segment or T-wave changes for prediction of major adverse cardiac events (MACE) after vascular surgery. EVIDENCE ACQUISITION: We searched PudMed, EMBASE and Cochrane Library databases for studies examining the relation between new ST-segment elevation or depression or T-wave inversion and MACE following vascular surgery. MACE was defined as fatal or non-fatal myocardial infarction, cardiac death, unstable angina, cardiac arrest, congestive heart failure, ischemic pulmonary edema, major ventricular arrhythmia or complete heart block. EVIDENCE SYNTHESIS: Eight eligible studies involving 1083 patients were included in meta-analysis. There was heterogeneity across included studies with possibility of publication bias. New ST-segment/T-wave changes had an imputed risk ratio (RR) for MACE of 2.04 (95% CI: 0.87 to 4.78). The overall predictive value was good (area under receiver-operating characteristic curve, 0.85; 95% CI: 0.83 to 0.90) with a sensitivity of 0.61 (95% CI: 0.55 to 0.67), specificity of 0.75 (95% CI: 0.72 to 0.78), and diagnostic odds ratio (DOR) of 13.03 (95% CI: 8.25 to 20.57). Meta-regression identified age (P value <0.01) and duration of ECG surveillance (P value <0.01) as possible sources for observed heterogeneity in RR. Neither factor influenced the DOR (P value, 0.87 and 0.36, respectively). CONCLUSIONS: Current evidence suggests that in the setting of vascular surgery, new ST-segment/T-wave changes could serve as predictor of MACE with reasonable accuracy. Heterogeneity across studies, possibility of publication bias and paucity of eligible studies are potential limitations to these conclusions.