OBJECTIVE: The added value of a preoperative electrocardiogram (ECG) in the prediction of postoperative myocardial infarction (POMI) and death was compared with clinical risk factors identified from the patient's history. SUMMARY OF BACKGROUND DATA: An ECG is frequently performed before surgery to screen for asymptomatic coronary artery disease. However, the value of ECG abnormalities to predict POMI has been questioned. METHODS: The study included 2967 noncardiac surgery patients >50 years of age from 2 university hospitals, who were expected to stay in the hospital for >24 hours. All data were obtained from electronic record-keeping systems. Patient history and ECG abnormalities were considered as potential predictors. Multivariate logistic regression analysis was used to obtain the independent predictors of POMI and all-cause in-hospital mortality. The area under the receiver operating characteristic curve (ROC area) was estimated to evaluate the ability of different models to discriminate between patients with and without the outcome. RESULTS: A preoperative ECG was available in 2422 patients (80%) and 1087 (45%) of the ECGs showed at least one abnormality. The ROC area of the model that included the independent predictors of POMI obtained from patient history, ie, ischemic heart disease and high-risk surgery, was 0.80. ECG abnormalities that were associated with POMI were a right and a left bundle branch block. After adding these abnormalities in the regression model, the ROC area remained 0.80. Similar results were found for all-cause mortality. CONCLUSIONS: Bundle branch blocks identified on the preoperative ECG were related to POMI and death but did not improve prediction beyond risk factors identified on patient history.
OBJECTIVE: The added value of a preoperative electrocardiogram (ECG) in the prediction of postoperative myocardial infarction (POMI) and death was compared with clinical risk factors identified from the patient's history. SUMMARY OF BACKGROUND DATA: An ECG is frequently performed before surgery to screen for asymptomatic coronary artery disease. However, the value of ECG abnormalities to predict POMI has been questioned. METHODS: The study included 2967 noncardiac surgery patients >50 years of age from 2 university hospitals, who were expected to stay in the hospital for >24 hours. All data were obtained from electronic record-keeping systems. Patient history and ECG abnormalities were considered as potential predictors. Multivariate logistic regression analysis was used to obtain the independent predictors of POMI and all-cause in-hospital mortality. The area under the receiver operating characteristic curve (ROC area) was estimated to evaluate the ability of different models to discriminate between patients with and without the outcome. RESULTS: A preoperative ECG was available in 2422 patients (80%) and 1087 (45%) of the ECGs showed at least one abnormality. The ROC area of the model that included the independent predictors of POMI obtained from patient history, ie, ischemic heart disease and high-risk surgery, was 0.80. ECG abnormalities that were associated with POMI were a right and a left bundle branch block. After adding these abnormalities in the regression model, the ROC area remained 0.80. Similar results were found for all-cause mortality. CONCLUSIONS: Bundle branch blocks identified on the preoperative ECG were related to POMI and death but did not improve prediction beyond risk factors identified on patient history.
Authors: O D Schein; J Katz; E B Bass; J M Tielsch; L H Lubomski; M A Feldman; B G Petty; E P Steinberg Journal: N Engl J Med Date: 2000-01-20 Impact factor: 91.245
Authors: Peter G Noordzij; Eric Boersma; Jeroen J Bax; Harm H H Feringa; Frodo Schreiner; Olaf Schouten; Miklos D Kertai; Jan Klein; Hero van Urk; Abdou Elhendy; Don Poldermans Journal: Am J Cardiol Date: 2006-02-28 Impact factor: 2.778
Authors: Wilton A van Klei; Karel G M Moons; Charles L G Rutten; Anke Schuurhuis; Johannes T A Knape; Cornelis J Kalkman; Diederick E Grobbee Journal: Anesth Analg Date: 2002-03 Impact factor: 5.108
Authors: W A van Klei; D E Grobbee; C L G Rutten; P J Hennis; J T A Knape; C J Kalkman; K G M Moons Journal: Eur J Anaesthesiol Date: 2003-08 Impact factor: 4.330
Authors: Christopher J Payne; Alexander R Payne; Simon C Gibson; Alan G Jardine; Colin Berry; David B Kingsmore Journal: World J Surg Date: 2011-12 Impact factor: 3.352
Authors: Danielle Menosi Gualandro; Pai Ching Yu; Bruno Caramelli; André Coelho Marques; Daniela Calderaro; Luciana Savoy Fornari; Claudio Pinho; Alina Coutinho Rodrigues Feitosa; Carisi Anne Polanczyk; Carlos Eduardo Rochitte; Carlos Jardim; Carolina L Z Vieira; Debora Y M Nakamura; Denise Iezzi; Dirk Schreen; Eduardo Leal Adam; Elbio Antonio D'Amico; Emerson Q de Lima; Emmanuel de Almeida Burdmann; Enrique Indalecio Pachón Mateo; Fabiana Goulart Marcondes Braga; Fabio S Machado; Flavio J de Paula; Gabriel Assis Lopes do Carmo; Gilson Soares Feitosa-Filho; Gustavo Faibischew Prado; Heno Ferreira Lopes; João R C Fernandes; José J G de Lima; Luciana Sacilotto; Luciano Ferreira Drager; Luciano Janussi Vacanti; Luis Eduardo Paim Rohde; Luis F L Prada; Luis Henrique Wolff Gowdak; Marcelo Luiz Campos Vieira; Maristela Camargo Monachini; Milena Frota Macatrão-Costa; Milena Ribeiro Paixão; Mucio Tavares de Oliveira; Patricia Cury; Paula R Villaça; Pedro Silvio Farsky; Rinaldo F Siciliano; Roberto Henrique Heinisch; Rogerio Souza; Sandra F M Gualandro; Tarso Augusto Duenhas Accorsi; Wilson Mathias Journal: Arq Bras Cardiol Date: 2017 Jan-Feb Impact factor: 2.000
Authors: André Arpad Faludi; Maria Cristina de Oliveira Izar; José Francisco Kerr Saraiva; Ana Paula Marte Chacra; Henrique Tria Bianco; Abrahão Afiune; Adriana Bertolami; Alexandre C Pereira; Ana Maria Lottenberg; Andrei C Sposito; Antonio Carlos Palandri Chagas; Antonio Casella; Antônio Felipe Simão; Aristóteles Comte de Alencar; Bruno Caramelli; Carlos Costa Magalhães; Carlos Eduardo Negrão; Carlos Eduardo Dos Santos Ferreira; Carlos Scherr; Claudine Maria Alves Feio; Cristiane Kovacs; Daniel Branco de Araújo; Daniel Magnoni; Daniela Calderaro; Danielle Menosi Gualandro; Edgard Pessoa de Mello; Elizabeth Regina Giunco Alexandre; Emília Inoue Sato; Emilio Hideyuki Moriguchi; Fabiana Hanna Rached; Fábio César Dos Santos; Fernando Henpin Yue Cesena; Francisco Antonio Helfenstein Fonseca; Henrique Andrade Rodrigues da Fonseca; Hermes Toros Xavier; Isabela Cardoso Pimentel Mota; Isabela de Carlos Back Giuliano; Jaqueline Scholz Issa; Jayme Diament; João Bosco Pesquero; José Ernesto Dos Santos; José Rocha Faria; José Xavier de Melo; Juliana Tieko Kato; Kerginaldo Paulo Torres; Marcelo Chiara Bertolami; Marcelo Heitor Vieira Assad; Márcio Hiroshi Miname; Marileia Scartezini; Neusa Assumpta Forti; Otávio Rizzi Coelho; Raul Cavalcante Maranhão; Raul Dias Dos Santos; Renato Jorge Alves; Roberta Lara Cassani; Roberto Tadeu Barcellos Betti; Tales de Carvalho; Tânia Leme da Rocha Martinez; Viviane Zorzanelli Rocha Giraldez; Wilson Salgado Journal: Arq Bras Cardiol Date: 2017-07 Impact factor: 2.000