Document Detail

Silent myocardial ischemia is not predictive of myocardial infarction in peripheral vascular surgery patients.
MedLine Citation:
PMID:  8518116     Owner:  NLM     Status:  MEDLINE    
Continuous ambulatory ECG (CAECG) monitoring has been advocated as an effective low-cost preoperative method for detecting silent myocardial ischemia in patients undergoing peripheral vascular surgery. In addition, silent ischemic events are associated with an increased incidence of postoperative myocardial infarctions. Ninety-six patients (mean age 73 years) admitted for elective aortic (24) or infrainguinal (72) operations over a 2-year period underwent 24-hour two- or three-lead CAECG monitoring. Results were reviewed by a single cardiologist blinded to the study. The criterion for ischemia was ST segment depressions of 1 mm or greater for 40 seconds or more 60 msec after the J point. Postoperative myocardial infarction was determined by ECG changes and/or elevated serum creatinine phosphokinase with positive MB isoenzymes. Risk factors included hypertension (71%), history of coronary artery disease (66%), smoking (61%), and diabetes mellitus (47%). Nine out of 96 patients (9.4%) had a positive CAECG test for silent myocardial ischemia. Only one patient (11.1%) developed postoperative myocardial infarction and there were no deaths in this group. The incidence of postoperative myocardial infarction in the nonischemic group was 16.1% (14/87). However, the mortality in this group was 6.9% (6/87). New and malignant arrhythmias requiring preoperative medical intervention were observed in seven patients (7.4%): two cases of ventricular tachycardia and five cases of atrial flutter/fibrillation. Contrary to previous reports, CAECG monitoring for silent ischemia was not a significant predictor of postoperative myocardial infarction or mortality in our patient population. However, we continue to recommend the preoperative use of CAECG monitoring as a diagnostic tool for unsuspected malignant arrhythmias.
J D Kirwin; E Ascer; M Gennaro; C Mohan; S Jonas; W Yorkovich; R Matano
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  7     ISSN:  0890-5096     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  1993 Jan 
Date Detail:
Created Date:  1993-07-29     Completed Date:  1993-07-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  27-32     Citation Subset:  IM    
Division of Vascular Surgery, Maimonides Medical Center, State University of New York, New York.
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MeSH Terms
Aged, 80 and over
Clinical Enzyme Tests
Electrocardiography, Ambulatory
Middle Aged
Myocardial Infarction / complications,  diagnosis*
Myocardial Ischemia / complications,  diagnosis*
Postoperative Complications / diagnosis*
Prospective Studies
Risk Factors
Vascular Surgical Procedures*

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

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