Electrocardiography is commonly performed as part of preoperative cardiovascular risk
assessment in patients undergoing noncardiac surgery. However, the prognostic value
of such electrocardiography is still not clear. This study retrospectively studied
23,036 patients who underwent 28,457 surgical procedures at Erasmus Medical Center
from 1991 to 2000. Patients were screened before surgery by type of surgery, cardiovascular
risk factors (history of coronary heart disease, heart failure, diabetes mellitus,
renal dysfunction, and stroke), and preoperative electrocardiography. Electrocardiographic
(ECG) results showing atrial fibrillation, left or right bundle branch block, left
ventricular hypertrophy, premature ventricular complexes, pacemaker rhythm, or Q-wave
or ST-segment changes were classified as abnormal. Multivariate logistic regression
was applied to evaluate the relation between ECG abnormalities and cardiovascular
death. In-hospital cardiovascular death was observed in 199 of 28,457 patients (0.7%).
Patients with abnormal ECG findings had a greater incidence of cardiovascular death
than those with normal ECG results (1.8% vs 0.3%; adjusted odds ratio 4.5, 95% confidence
interval 3.3 to 6.0). Adding ECG data to clinical risk factors and the type of surgery
resulted in an improved C index for the prediction of cardiovascular death (0.79 vs
0.72). However, in patients who underwent low-risk or low- to intermediate-risk surgery,
the absolute difference in the incidence of cardiovascular death between those with
and without ECG abnormalities was only 0.5%. In conclusion, preoperative electrocardiography
provides prognostic information in addition to clinical characteristics and the type
of surgery. However, the usefulness of its routine use in lower risk surgery is questionable.
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References
- Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.Circulation. 1999; 100: 1043-1049
- Perioperative cardiovascular mortality in 108613 non-cardiac surgical procedures.Am J Med. 2005; 118: 1134-1141
- Clinical application of a second generation electrocardiographic computer program.Am J Cardiol. 1975; 35: 597-608
Mortara Instrument, Inc. Heart of Mortara. Available at: http://www.mortara.com/oem_diagnosticecg_rest.htm.
ICD-9-CM. International Classification of Diseases, 9th edition, Clinical Modification. 3rd Ed, volumes 1, 2 and 3. Official authorized addendum effective October 1, 1990—HCFA. J Am Med Rec Assoc 1990;61(suppl):1–35.
- Optimizing the prediction of perioperative mortality in vascular surgery by using a customized probability model.Arch Intern Med. 2005; 165: 898-904
- Multifactorial index of cardiac risk in noncardiac surgical procedures.N Engl J Med. 1977; 297: 845-850
- Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index.Arch Intern Med. 1986; 146: 2131-2134
- The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery.N Engl J Med. 2000; 342: 168-175
- Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients.J Am Geriatr Soc. 2002; 50: 1186-1191
Article info
Publication history
Published online: February 27, 2006
Accepted:
October 31,
2005
Received in revised form:
October 31,
2005
Received:
June 19,
2005
Identification
Copyright
© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
