Post-operative electrocardiographic changes in intermediate-high risk patients undergoing non-cardiac surgery - The 67th Annual Conference of the Israel Heart Society

Gil Marcus ^1,2,3 Adriana Zilberstein ⁶ Ilya Kumetz ^2,3 Itamar Y. Love ^2,3 Bethlehem Mengesha ^2,3 Faina Tsiporin ^2,3 Mony Shuvy ⁴ David Pereg ^3,5 Lucas C. Godoy ¹ Zoya Haitov ⁶ Ilya Litovchik ^2,3 Shmuel Fuchs ^2,3 Sa'ar Minha ^2,3

¹Peter Munk Cardiac Centre, Toronto General Hospital, Canada
²Cardiology, Shamir Medical Center, Zerifin, Israel
³Sackler School of Medicine, Tel-Aviv University, Israel
⁴Cardiology, Hadassah-Hebrew University, Israel
⁵Cardiology, Meir Medical Center, Israel
⁶Anesthesiology, Shamir Medical Center, Zerifin, Israel

Introduction: Non-cardiac surgeries impose stress on patients which in turn may be associated with increased risk for poor cardiovascular outcomes. Efforts to mitigate this risk focus on peri-operative assessment of risk and at most times include a pre-procedural electrocardiogram (ECG). During surgery, the patient is anesthetized at most times and thus clinical events such as chest pain are undetected. The merits of routine post-operative ECG as a screening aid for events occurring during surgery are unknown. This study was aimed to explore the incidence of pre and post procedural ECG pathologies in intermediate-high risk population undergoing non-cardiac surgery.

Methods: This single center, prospective study included patients older than 18 years with at least 2 relevant cardiovascular risk factors who were scheduled for non-cardiac surgery. All patients had pre and post procedural ECG. ECG was analyzed by two cardiologists independently and were coded according to the Minnesota criteria. The primary endpoint was new post-procedural ECG changes. A comparative analysis was performed between patients with the primary end point and those without it.

Results: A total of 217 patients were enrolled. Pre-operative pathologic ECG changes were recorded in 62.2% of patients (mostly axis abnormalities (18.5% ) and Q-waves (14.8%)) Post-operatively, new pathologic changes in the ECG were documented in 49.8% of patients, most commonly T-wave changes (50.9%), followed by new Q-waves (15.7%),axis shift (14.8%), ST-segment depression (13%) and ventricular conduction delays (9.3%). Ischemic heart disease, high fluid replacement and pre-operative ECG pathologies were among the independent co-variates associated with new post-operative ECG changes.

Conclusions: Post-operative ECG changes are common in patients at intermediate-high risk for cardiovascular events and may indicate a silent cardiovascular event occurred during surgery. Routine performance of this simple auxiliary test may be beneficial for diagnosis establishment and may also be associated with improved outcome.