Perioperative ST-segment depression is rare and may not indicate myocardial ischemia in moderate-risk patients undergoing noncardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia

Volumn 11, Issue 2, 1997, Pages 155-159

  Fleisher, Lee A ^a,b   Zielski, Michelle M ^a   Schulman, Steven P ^a  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b JOHNS HOPKINS HOSPITAL   (United States)

Author keywords

anesthesia; Bayes theorem; electrocardiography; monitoring; myocardial ischemia; postoperative; surgery

Indexed keywords

ABDOMINAL SURGERY; ADULT; AGED; ARTICLE; CONTROLLED STUDY; CORONARY ARTERY DISEASE; ELECTROCARDIOGRAPHY MONITORING; EXERCISE TEST; FEMALE; FOLLOW UP; HEAD AND NECK SURGERY; HEART MUSCLE ISCHEMIA; HUMAN; MAJOR CLINICAL STUDY; MALE; NEUROSURGERY; ORTHOPEDIC SURGERY; PERIOPERATIVE PERIOD; POSTOPERATIVE PERIOD; PRIORITY JOURNAL; ST SEGMENT DEPRESSION;

EID: 0031003951     PISSN: 10530770     EISSN: None     Source Type: Journal    
DOI: 10.1016/S1053-0770(97)90205-6     Document Type: Article

References (29)

1. Mangano DT, Browner WS, Hollenberg M, et al: Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 323:1781-1788, 1990
2. Mangano DT, Hollenberg M, Fegert G, et al: Perioperative myocardial ischemia in patient undergoing noncardiac surgery - I: Incidence and severity during the 4 day perioperative period. Am Coll Cardiol 17:843-850, 1991
3. Mangano DT, Wong MG, London MJ, et al: Perioperative myocardial ischemia in patients undergoing noncardiac surgery - II: Incidence and severity during the 1st week after surgery: The Study of Perioperative Ischemia (SPI) Research Group. J Am Coll Cardiol 17:851-857, 1991
4. McCann RL, Clements FM: Silent myocardial ischemia in patients undergoing peripheral vascular surgery: Incidence and association with perioperative cardiac morbidity and mortality. J Vasc Surg 9:583-587, 1989
5. Ouyang P, Gerstenblith G, Furman WR, et al: Frequency and significance of early postoperative silent myocardial ischemia in patients having peripheral vascular surgery. Am J Cardiol 64:1113-1116, 1989
6. Pasternack PF, Grossi EA, Baumann FG, et al: The value of silent myocardial ischemia monitoring in the prediction of perioperative myocardial infarction in patients undergoing peripheral vascular surgery. J Vasc Surg 10:617-625, 1989
7. Raby KE, Barry J, Creager MA, et al: Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA 268:222-227, 1992
8. Fleisher LA, Nelson AH, Rosenbaum SH: Postoperative myocardial ischemia: Etiology of cardiac morbidity or manifestation of underlying disease. J Clin Anesth 7:97-102, 1995
9. Fleisher L, Rosenbaum S, Nelson A, et al: The predictive value of preoperative silent ischemia for postoperative ischemic cardiac events in vascular and non vascular surgical patients. Am Heart J 122:980-986, 1991
10. Christopherson R, Beattie C, Frank SM, et al: Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology 79:422-434, 1993
11. Landesberg G, Luria MH, Cotev S, et al: Importance of long-duration postoperative ST-segment depression in cardiac morbidity after vascular surgery. Lancet 341:715-719, 1993
12. Mathew JP, Fleisher LA, Rinehouse JA, et al: ST segment depression during labor and delivery. Anesthesiology 77:635-641, 1992
13. Palmer CM, Norris MC, Giudici MC, et al: Incidence of electrocardiographic changes during cesarean delivery under regional anesthesia. Anesth Analg 70:36-43, 1990
14. Shuman P: Bayes' theorem: A review. Cardiol Clin 2:319-328, 1984
15. Pasternac PF, Grossi EA, Baumann FG, et al: The value of silent myocardial ischemia monitoring in the prediction of perioperative myocardial infarction in patients undergoing peripheral vascular surgery. J Vasc Surg 10:617-625, 1989
16. Raby KE, Goldman L, Creager MA, et al: Correlation between perioperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 321:1296-1300, 1989
17. Cohn K, Kamm B, Feteih N, et al: Use of treadmill score to quantify ischemic response and predict extent of coronary disease. Circulation 59:286-296, 1979
18. Goldschlager N, Selzer A, Cohn K: Treadmill stress tests as indicators of presence and severity of coronary artery disease. Ann Intern Med 85:277-286, 1976
19. Rifkin RD, Hood WB Jr: Bayesian analysis of electrocardiographic exercise stress testing. N Engl J Med 297:681-686, 1977
20. Simoons ML, Hugenholtz PG: Estimation of the probability of exercise-induced ischemia by quantitative ECG analysis. Circulation 56:552-559, 1977
21. Deanfield JE, Maseri A, Selwyn AP, et al: Myocardial ischemia during daily life in patients with stable angina: Its relation to symptoms and heart rate changes. Lancet 2:753-758, 1983
22. Gottlieb SO, Weisfeldt ML, Ouyang P, et al: Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina. N Engl J Med 314:1241-1249, 1986
23. Gottlieb SO, Gottlieb SH, Achuff SC, et al: Silent ischemia on Holter monitoring predicts mortality in high risk postinfarction patients. JAMA 259:1030-1035, 1988
24. Hedblad B, Juul-Moller S, Svensson K, et al: Increased mortality in men with ST segment depression during 24 h ambulatory long-term ECG recording: Results from prospective population study 'Men born in 1914', from Malmo, Sweden. Eur Heart J 10:149-158, 1989
25. Ambrose JA, Tannenbaum MA, Alexopoulos D, et al: Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol 12:56-62, 1988
26. Mangano DT, Browner WS, Hollenberg M, et al: Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group. JAMA 268:233-239, 1992
27. Detrano R, Gianrossi R, Mulvihill D, et al: Exercise-induced ST segment depression in the diagnosis of multivessel coronary disease: A meta analysis. J Am Coll Cardiol 14:1501-1508, 1989
28. Ellis JE, Drijvers G, Pedlow S, et al: Premedication with oral and transdermal clonidine provides safe and efficacious postoperative sympatholysis. Anesth Analg 79:1133-1140, 1994
29. Marsch SC, Schaefer HG, Skarvan K, et al: Perioperative myocardial ischemia in patients undergoing elective hip arthroplasty during lumbar regional anesthesia. Anesthesiology 76:518-527, 1992