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Pathologic Q Waves and Prolonged QTc Time in Preoperative ECG Are Predictive for Perioperative Cardiovascular Events

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World Journal of Cardiovascular Diseases 2014年第10期4卷 498-509页

作者： Thomas Wolters Michael Weber Thomas Neumann Hans-Georg Strauß Andreas Luchner Manfred Seeberger Christian Mueller Christoph Liebetrau Svetlana Apostolovic Radmilo Jankovic Dragic Bankovic Marina Jovic Vesselin Mitrovic Holger Nef Helge Mollmann Karl Werdan Christian W. Hamm Axel Schlitt Department of Medicine III University Clinic Halle (Saale) Halle Germany Department of Medicine Clinic Grabs Grabs Switzerland Department of Cardiology Kerckhoff Heart and Thorax Center Bad Nauheim Germany Department of Medicine II Clinic Gro&szlig -umstadt Gro&szlig -umstadt Germany Department of Medicine II University of Regensburg Regensburg Germany Department of Cardiology University of Basel Basel Switzerland University Cardiology Clinic Ni&scaron Serbia Department of Mathematical Sciences University of Kragujevac Kragujevac Serbia Department of Medicine I University Clinic of Gie&szlig en and Marburg Gie&szlig en Germany Department of Medicine I Paracelsus-Harz-Clinic Bad Suderode Quedlinburg Germany

Aims: The value of ECG in the perioperative risk stratification under modern treatment options is uncertain. The main objective of the present analysis was to determine the usefulness of a pre-operative ECG derivation for evaluating the risk of perioperative morbidity and mortality. Methods: We performed a secondary analysis of the prospective, international, multicenter, observational “No-Risk” Study (N-terminal B-type natriuretic peptide [NT-proBNP] for the assessment of the perioperative cardiac risk after major noncardiac surgery) to determine the prognostic value of 12-lead ECG. Inclusion criteria were age >55 years and at least one of the following cardiovascular risk factors: arterial hypertension, diabetes mellitus, dyslipidemia, active smoking, and family history positive for coronary heart disease. The combined primary endpoint included total mortality, acute myocardial infarction (NSTEMI and STEMI), cardiopulmonary resuscitation, heart failure, and asystole or ventricular fibrillation during hospitalization. ECGs from 616 patients enrolled from 2006 to 2009 prior to noncardiac surgery in the No-Risk Study were analyzed. Results: The mean age was 67.6 (±8.1) years;300 (48.7%) patients were male. Fourteen (2.3%) patients suffered from the combined primary endpoint while in the hospital. In Kaplan-Meier analyses, a pathologic Q wave and QTc > 500 ms were significantly related to the incidence of the primary endpoint (p p = 0.042, respectively), whereas other ECG parameters such as LBBB, RBBB, PQ interval, QRS interval, and others were not related to worse in-hospital outcome. Conclusion: The 12-lead ECG is still an important diagnostic tool for perioperative risk assessment of cardiovascular events in noncardiac surgery in patients at risk.

关键词： ECG Perioperative Risk Cardiovascular Risk

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