Document Detail


Duration of preoperative electrocardiographic QRS complex and the incidence of heart arrest after aorto coronary bypass surgery.
MedLine Citation:
PMID:  10872708     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Sudden heart arrest (HA) in the early phase after aorto coronary bypass surgery represents a serious event necessitating resuscitation, and for those who survive usually also an extra stay in the coronary care unit. Since such episodes of heart standstill may be related to conduction defects, a study was conducted to determine whether the duration of the QRS complex on the preoperative ECG is a marker for this morbid event. A cohort of 1011 consecutive patients operated on between 1982 and 1986 and followed to January 1st, 1993 were included in the study. Incidence of lethal or non-lethal HA during the first 4 weeks after surgery was considered as the primary endpoint and total mortality as the secondary endpoint. The incidence of HA was 40/1011 = 4%, with the majority of events (60%) being lethal. Independent risk factors of HA using the multivariate logistic model were previous coronary artery bypass surgery, presence of mitral regurgitation, left ventricular ejection fraction and the intraoperative cross-clamp time of aorta. Adjusting for the effect of confounder variables showed that the gradient effect of QRS complex duration on the endpoint HA was still present (p = 0.012). The duration of the QRS complex taken from the preoperative ECG had a gradient effect on the incidence of HA. With a baseline level of QRS <70 ms, the following odds ratios (OR) for HA were found: OR = 1.38 (95% CI 0.60-3.31) for QRS 70-80 ms; OR = 2.27 (95% CI 0.87-5.90) for QRS >90-120 ms; and OR = 3.38 (95% CI 1.06-11.50) for QRS > 120 ms, when adjusting for the risk factors. Cumulative survival at 5 years after surgery was 28+/-7.1% for patients experiencing HA versus 87+/-1.2% for patients free from this event. Our results underline the importance of the QRS complex duration as a preoperative marker for HA after aorta coronary bypass surgery, when adjusting for other risk factors. Although the one-year survival is poor for patients experiencing HA, there is no increase in mortality during the late follow-up.
Authors:
M Abdelnoor; S Nitter-Hauge; O Risum; J L Svennevig; J P Amlie
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Scandinavian cardiovascular journal : SCJ     Volume:  34     ISSN:  1401-7431     ISO Abbreviation:  Scand. Cardiovasc. J.     Publication Date:  2000  
Date Detail:
Created Date:  2000-11-03     Completed Date:  2000-11-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9708377     Medline TA:  Scand Cardiovasc J     Country:  NORWAY    
Other Details:
Languages:  eng     Pagination:  186-91     Citation Subset:  IM    
Affiliation:
Clinical Epidemiology Unit, Ullevål Hospital, Oslo, Norway.
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Bypass / adverse effects*
Electrocardiography*
Female
Heart Arrest / epidemiology*,  etiology
Humans
Incidence
Male
Middle Aged
Preoperative Care
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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