Failure to predict intraoperative myocardial ischaemia in patients with coronary artery disease

Patients with severe coronary artery disease were studied to determine if the preoperative assessment or intraoperative haemodynamic monitoring could predict the occurrence of myocardial ischaemia. Thirty-eight patients undergoing coronary artery surgery who had normal electrocardiograms before induction of anaesthesia were included. Leads II and CS5 were recorded on a Holter monitor and radial arterial and pulmonary artery catheters were used to measure haemodynamic variables. Eight patients developed ST-segment changes greater than or equal to 0.1 mV before sternotomy. Preoperative factors could not be used to predict which patients would develop ST-segment changes. In all 38 patients haemodynamic determinants of myocardial oxygen supply and demand remained within an optimal range despite evidence of ischaemia in eight. This syndrome of ECG changes in the absence of tachycardia and hypertension resembles the syndrome of silent ischaemia documented in awake patients. Our findings suggest that myocardial ischaemia may be caused by decreases in coronary blood flow not associated with changes in haemodynamic variables.