Association Between Continuously Recorded ST Changes and Perioperative Myocardial Injury: An Explorative Prospective
Arman Valadkhani1,2, Samuel Bruchfeld3,4,5, Anil Gupta1,2
1From the Function Perioperative Medicine and Intensive Care (PMI) and Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
A&A Practice
|July 22, 2026
Summary
Continuous ST-segment monitoring can detect perioperative myocardial injury (PMI) in high-risk surgery patients. ST-depression, not ST-elevation, significantly correlates with PMI, aiding early detection and improved outcomes.
Area of Science:
- Cardiology
- Anesthesiology
- Vascular Surgery
Background:
- Perioperative myocardial injury (PMI) increases mortality after noncardiac surgery.
- Nonsymptomatic surveillance is crucial due to blunted ischemic symptoms from perioperative analgesics.
- The link between ST-segment deviation and PMI is not well understood.
Purpose of the Study:
- To investigate the association between continuous perioperative ST-segment monitoring and PMI.
- To assess ST-segment deviations in patients undergoing intermediate- to high-risk vascular surgery.
Main Methods:
- Prospective, single-center cohort study.
- Continuous six-lead electrocardiography (ECG) with ST-segment analysis.
- PMI defined by elevated high-sensitivity cardiac troponin T.
- Multivariable Poisson regression analysis.
Main Results:
- 498 patients included; 9% experienced PMI.
- ST-depression significantly associated with PMI (aRR 3.85).
- Absolute ST-segment deviation >1mm also linked to PMI (RR 2.03).
Conclusions:
- ST-depression meeting myocardial infarction criteria and ST deviations >1mm are associated with PMI.
- Continuous ST-segment monitoring can aid in PMI detection.
