Postoperative Cardiac Ischemia Detection by Continuous 12-Lead Electrocardiographic Monitoring in Vascular Surgery Patients : A Prospective, Observational Study

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Ollila , A , Virolainen , J , Vanhatalo , J , Vikatmaa , P , Tikkanen , I , Venermo , M , Salmenpera , M , Pettila , V & Vikatmaa , L 2017 , ' Postoperative Cardiac Ischemia Detection by Continuous 12-Lead Electrocardiographic Monitoring in Vascular Surgery Patients : A Prospective, Observational Study ' , Journal of Cardiothoracic and Vascular Anesthesia , vol. 31 , no. 3 , pp. 950-956 . https://doi.org/10.1053/j.jvca.2016.09.027

Title: Postoperative Cardiac Ischemia Detection by Continuous 12-Lead Electrocardiographic Monitoring in Vascular Surgery Patients : A Prospective, Observational Study
Author: Ollila, Aino; Virolainen, Juha; Vanhatalo, Joonas; Vikatmaa, Pirkka; Tikkanen, Ilkka; Venermo, Maarit; Salmenpera, Markku; Pettila, Ville; Vikatmaa, Leena
Contributor: University of Helsinki, Kardiologian yksikkö
University of Helsinki, Verisuonikirurgian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Department of Diagnostics and Therapeutics
Date: 2017-06
Language: eng
Number of pages: 7
Belongs to series: Journal of Cardiothoracic and Vascular Anesthesia
ISSN: 1053-0770
URI: http://hdl.handle.net/10138/297843
Abstract: Objectives: Elderly patients undergoing vascular surgery are at major risk for perioperative cardiac complications. The authors investigated continuous electrocardiographic Holter monitoring in a postoperative setting to determine the degree of postoperative ischemic load and its possible associations with perioperative myocardial infarction. Design: A prospective, observational study. Setting: One university hospital. Participants: The study comprised 51 patients aged 65 years or older undergoing peripheral arterial surgery. Interventions: Continuous electrocardiographic monitoring with a Holier device was started postoperatively and continued for 72 hours or until discharge. Postural changes were recorded using a 3-axis accelerometer. Standard 12-lead electrocardiography, high-sensitive troponin T measurements, and an inquiry of ischemic symptoms were performed 4 times perioperatively. Measurements and Main Results: The primary outcomes were ischemic load (area under the function of ischemic ST-segment deviation and ischemic time) and perioperative myocardial infarction. During 3,262.7 patient-hours of monitoring, 17 patients (33.3%) experienced 608 transient ischemic events, all denoted by ST-segment depression. Of these 17 patients, 5 experienced perioperative myocardial infarction. The mean ischemic load in all patients was 913.2 +/- 2,797.3 mu V x minute. Ischemic load predicted perioperative myocardial infarction, with an area under receiver operating characteristics curve (95% confidence interval) of 0.87 (0.75-0.99). Ischemic changes occurred most frequently during hours 24 to 60 of monitoring. Ischemia was asymptomatic in 14 of 17 patients (82.4%). Conclusion: Postoperative myocardial ischemia was common in peripheral vascular surgery patients and may progress to perioperative myocardial infarction. Ischemic load was a good predictor of perioperative myocardial infarction. Ambulatory electrocardiographic monitoring solutions for continuous postoperative ischemia detection are warranted in the surgical ward. (C) 2017 Elsevier Inc. All rights reserved.
Subject: vascular surgery
perioperative complications
cardiac ischemia
myocardial infarction
postoperative monitoring
Holter electrocardiography
high-sensitive troponin T
PERIOPERATIVE MYOCARDIAL-INFARCTION
3RD UNIVERSAL DEFINITION
NONCARDIAC SURGERY
PROGNOSTIC-SIGNIFICANCE
BETA-BLOCKADE
MORBIDITY
MORTALITY
DEATH
PATHOPHYSIOLOGY
VALIDATION
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
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