Perioperative myocardial ischemia: importance of the preoperative ischemic pattern

Abstract

Previous studies investigating the incidence of myocardial ischemia in patients undergoing coronary-artery bypass grafting (CABG) surgery have not considered the potential significance of the preoperative ischemic pattern in the development of intra- and postoperative myocardial ischemia and infarction. Accordingly, the authors compared the frequency and severity of pre-, intra-, and postoperative ischemic episodes (ST-segment depression greater than or equal to 0.1 mV or elevation greater than or equal to 0.2 mV) in 50 men with severe coronary artery disease scheduled for elective CABG. All subjects were monitored by continuous electrocardiography (ECG) (Holter monitor) for 2 preoperative days, intraoperatively, and 2 postoperative days (total monitoring time = 4,363 h). Routine anti-anginal medications were continued until the morning of surgery, and the anesthetic management of the patient was not controlled. During the preoperative period, 42% of the patients had ECG ischemic episodes, 87% of which were clinically silent. Only 18% developed intraoperative ischemia. Postoperatively, the incidence increased to 40%. The number of ischemic episodes/hour (epis/h) of monitoring among the three monitoring periods was similar (0.09 +/- 0.12 epis/h preoperatively, 0.11 +/- 0.20 epis/h intraoperatively, and 0.05 +/- 0.08 epis/h postoperatively; P = NS). The median duration of ischemic episodes was similar pre- and intraoperatively (16 vs. 18.5 min, P = NS), but greater postoperatively (41 min, P less than 0.05). Seventy-six per cent of the perioperative ECG ischemia occurred without acute change (+/- 20% of control) in blood pressure or heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)