Microvolt T-wave alternans at the end of surgery is associated with postoperative mortality in cardiac surgery...

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Clinical Outcomes Research

Background:

• Microvolt T-wave alternans (MTWA) indicates electrical repolarization dispersion, a known risk factor for arrhythmias and sudden cardiac death.
• Assessing MTWA in cardiac surgery patients may offer prognostic value for postoperative outcomes.

Purpose of the Study:

• To investigate the association between MTWA and both in-hospital and mid-term mortality following cardiac surgery.
• To evaluate the predictive performance of MTWA, alone and in combination with EuroSCORE II, for mortality.

Main Methods:

• Analysis of electrocardiograms from 330 cardiac surgery patients to measure MTWA at the end of surgery.
• Utilized official national data and electronic health records for in-hospital and mid-term outcome assessment.
• Employed univariate, multivariate, and Cox proportional hazards models to determine mortality associations.

Main Results:

• MTWA at the end of surgery was strongly associated with in-hospital mortality (OR 59.2, p<0.001) and mid-term mortality (HR 4.3, p<0.05).
• MTWA positive patients faced a 60-fold increase in in-hospital and a 4-fold increase in mid-term mortality.
• The predictive model for MTWA showed an AUC of 0.764, increasing to 0.929 when combined with EuroSCORE II.

Conclusions:

• MTWA measured post-cardiac surgery is an independent predictor of both in-hospital and mid-term mortality.
• Combining MTWA with EuroSCORE II significantly enhances the prediction of mortality in this patient cohort.
• MTWA provides valuable prognostic information for cardiac surgery patients, aiding in risk stratification.