The Predictive Value Of ST-Segment Changes On Preoperative Holter Recording In Patients With Cardiovascular Disease Undergoing Noncardiac Surgery

Objective: To test the ability of ST-segment changes on preoperative Holter recording to predict postoperative adverse cardiovascular events in patients with intermediate risk factors of cardiovascular disease undergoing noncardiac surgery. Methed: Fifty-eight patients, who were at a intermediate risk for postoperative cardiocvascular events according to the "ACC/AHA Guideline for Perioperative Cardiovascular Evaluation for Noncardiac surgery", were classified into two groups: group I (n=31) without ST-segment changes on preoperative Holter recording ; group II (n=27) with ST-segment changes (ST depress ≥0.05mv). Used Holter to moniter myocardial ischaemias and arrhythmias of all patients for 48 hours postoperative. Postoperative patients were followed in hospital. Cardiovascular events were defined, as death from a cardiac cause; myocardial infarction; unstable angina/myocardia damage; congestive cardiac failure; cerebrovascular accident; ventricular tachycardia and arrhythmias with hyper- or hypotension. Calculated the predictive value of preoperative ST-segment changes on Holter recording for postoperative cardiovascular events, and compared the difference of postoperative myocardia ischaemia and cardiovascular events between the two group. Result: During the monitored postoperative period, there were eight patients in group I and twenty-three patients in group II developed myocardial ischemia. During the study period, nine patients suffered postoperative cardiovascular events. One of them belonged to group I , and the others belonged to group II. there were statistically significant on postoperative morbid of cardiovascular events between two groups. Analysis ST-segment changes on preoperative Holter recording for postoperative cardiovascular events, its positive predictor value was 0.3, and negative predictor value was 0.97. The only one patient of group I, who sufferedpostoperative event, have not demonstrated myocardial ischaemia on postoperative Holter recording. In group II, eight patients with severe postoperative myocardial ischaemia demonstrated on Holter recording, sustained postoperative events. And the ischaemia load, frequency, longest ischaemia duration and cumulative ischemia duration ,which can represent the degree of myocardial ischaemia , were great more than the other patients. Conclusion: 1. The ST-segment changes (degree of ST depress 0.05mv) demonstrated on preoperative Holter is help to predict the postoperative cardiovascular events. 2. Strengthen the monitoring of postoperative myocardial ischemia of patients with Holter ST-segment changes can improve the ability to avoid serious cardiovascular events of postoperative.