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Perioperative ST-segment depression is rare and may not indicate myocardial ischemia in moderate-risk patients
L A Fleisher1, M M Zielski, S P Schulman
1Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Insights
ST-segment changes are uncommon in asymptomatic older adults undergoing surgery. These changes do not reliably indicate occult coronary artery disease, suggesting caution in diagnosis.
Area of Science:
- Cardiology
- Geriatric Medicine
- Perioperative Medicine
Background:
- ST-segment changes during surgery can be concerning.
- Identifying asymptomatic patients with occult coronary artery disease is clinically important.
Purpose of the Study:
- To determine the incidence of ST-segment changes in older asymptomatic patients undergoing noncardiac surgery.
- To assess the correlation between these ST-segment changes and occult coronary artery disease.
Main Methods:
- Prospective, single-center cohort study of 190 patients over 45 years old with coronary artery disease risk factors.
- Continuous electrocardiographic monitoring during and after surgery, exercise treadmill testing, and 24-month follow-up.
Main Results:
- Seven patients (3.7%) showed significant ST-segment changes intraoperatively or postoperatively.
- All three tested patients with ST-segment changes had negative exercise treadmill tests.
- No patients with ST-segment changes developed symptoms of coronary artery disease during follow-up.
Conclusions:
- ST-segment changes are rare in asymptomatic, moderate-risk patients during the perioperative period.
- The low incidence of positive stress tests and lack of symptoms suggest caution in diagnosing myocardial ischemia based solely on perioperative ST-segment changes.
Objective:
To identify a group of older asymptomatic patients in whom ST-segment changes are common and determine their correlation with occult coronary artery disease.
Design:
Prospective, cohort study.
Setting:
University hospital, single-center.
Participants:
Patients older than 45 years with at least one risk factor for coronary artery disease but without documented disease undergoing noncardiac, nonvascular surgery.
Interventions:
Intraoperative and early postoperative continuous electrocardiographic monitoring, exercise treadmill testing, 24-month telephone follow-up.
Measurements And Main Results:
A total of 190 patients were studied with a continuous ST-segment monitor, seven of whom demonstrated significant ST-segment changes during the intraoperative or early postoperative period. Three of the seven patients were evaluated by exercise treadmill testing, all of whom had a negative test. Follow-up was complete in 84% of the cohort without ST-segment changes and in all patients with ST-segment changes. One patient with perioperative ST-segment changes died of prostate cancer. None of the other patients showed any symptoms of coronary artery disease on follow-up.
Conclusions:
ST-segment changes are rare during the intraoperative and immediate postoperative period in asymptomatic patients at moderate risk for coronary artery disease. The low incidence of a positive stress test and lack of cardiovascular symptoms on follow-up in patients with perioperative ST-segment changes suggest that caution should be exercised before diagnosing myocardial ischemia and coronary artery disease.