Perioperative ST-depression was significantly associated with perioperative myocardial injury during vascular surgery (adjusted RR 3.85; 95% CI 1.86-7.94; P<0.001).
Cohort (n=498)
No
Is continuous perioperative ST-segment monitoring associated with perioperative myocardial injury in patients undergoing intermediate- to high-risk vascular surgery?
Continuous perioperative ST-segment monitoring, specifically detecting ST-depression and deviations >1 mm, is significantly associated with perioperative myocardial injury in vascular surgery patients.
Relative Risk: 3.85 (95% CI 1.86–7.94)
p-value: p=<.001
BACKGROUND: Perioperative myocardial injury (PMI) is associated with a higher mortality after noncardiac surgery. Ischemic symptoms are uncommon postoperatively due to analgesics used perioperatively, necessitating nonsymptomatic surveillance. Although ST-segment deviation indicates myocardial ischemia, its association with PMI remains poorly understood. This study explored the association between continuous perioperative ST-segment monitoring and PMI in patients undergoing intermediate- to high-risk vascular surgery. METHODS: This was a prospective, single-center cohort study. In addition to standard monitoring, all patients were monitored using a six-lead continuous electrocardiography (ECG) with ST-segment analysis perioperatively. ST events were analyzed according to the fourth universal myocardial infarction definition and as individualized deviations from lead-specific baseline values. The primary outcome was PMI, defined by an increase in high-sensitivity cardiac troponin T measured preoperatively and at 4 to 6, 24, and 48 hours postoperatively. Multivariable Poisson regression was used for primary analysis. RESULTS: In total, 498 patients were included, and 46 (9%) incurred PMI. ST-elevation was seen in 89 (18%) and not significantly associated with PMI (adjusted relative risk RR, 1.75; 95% confidence interval CI, 0.87-3.53; P = .12), whereas ST-depression was seen in 38 (8%) and showed a significant association with PMI (adjusted RR, 3.85; 95% CI, 1.86-7.94; P 1 mm from individualized lead baseline was also associated with PMI (RR, 2.03; 95% CI, 1.01-4.06; P = .046). When ST-depression was added to the baseline model, including age and the American Society of Anesthesiologists (ASA) physical status classification system, overall net risk classification improved (NRI, 0.50; 95% CI, 0.16-0.86). CONCLUSIONS: ST-depression meeting universal myocardial infarction criteria and ST deviations >1 mm from individualized baseline were associated with PMI. Intra- and postoperative ST-segment monitoring may facilitate detection of PMI.
Valadkhani et al. (Wed,) conducted a cohort in Intermediate- to high-risk vascular surgery (n=498). Perioperative ST-depression vs. No ST-depression was evaluated on Perioperative myocardial injury (PMI), defined by an increase in high-sensitivity cardiac troponin T (adjusted RR 3.85, 95% CI 1.86-7.94, p=<.001). Perioperative ST-depression was significantly associated with perioperative myocardial injury during vascular surgery (adjusted RR 3.85; 95% CI 1.86-7.94; P<0.001).