Postoperative Cardiac Ischemia Detection by Continuous 12-Lead Electrocardiographic Monitoring in Vascular Surgery Patients: A Prospective, Observational Study.

Ollila, Aino; Virolainen, Juha; Vanhatalo, Joonas; Vikatmaa, Pirkka; Tikkanen, Ilkka; Venermo, Maarit; Salmenperä, Markku; Pettilä, Ville Yrjö Olavi; Vikatmaa, Leena (2017). Postoperative Cardiac Ischemia Detection by Continuous 12-Lead Electrocardiographic Monitoring in Vascular Surgery Patients: A Prospective, Observational Study. Journal of cardiothoracic and vascular anesthesia, 31(3), pp. 950-956. Elsevier 10.1053/j.jvca.2016.09.027

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OBJECTIVES Elderly patients undergoing vascular surgery are at major risk for perioperative cardiac complications. The authors investigated continuous electrocardiographic Holter monitoring in a postoperative setting to determine the degree of postoperative ischemic load and its possible associations with perioperative myocardial infarction. DESIGN A prospective, observational study. SETTING One university hospital. PARTICIPANTS The study comprised 51 patients aged 65 years or older undergoing peripheral arterial surgery. INTERVENTIONS Continuous electrocardiographic monitoring with a Holter device was started postoperatively and continued for 72 hours or until discharge. Postural changes were recorded using a 3-axis accelerometer. Standard 12-lead electrocardiography, high-sensitive troponin T measurements, and an inquiry of ischemic symptoms were performed 4 times perioperatively. MEASUREMENTS AND MAIN RESULTS The primary outcomes were ischemic load (area under the function of ischemic ST-segment deviation and ischemic time) and perioperative myocardial infarction. During 3,262.7 patient-hours of monitoring, 17 patients (33.3%) experienced 608 transient ischemic events, all denoted by ST-segment depression. Of these 17 patients, 5 experienced perioperative myocardial infarction. The mean ischemic load in all patients was 913.2±2,797.3 µV×minute. Ischemic load predicted perioperative myocardial infarction, with an area under receiver operating characteristics curve (95% confidence interval) of 0.87 (0.75-0.99). Ischemic changes occurred most frequently during hours 24 to 60 of monitoring. Ischemia was asymptomatic in 14 of 17 patients (82.4%). CONCLUSION Postoperative myocardial ischemia was common in peripheral vascular surgery patients and may progress to perioperative myocardial infarction. Ischemic load was a good predictor of perioperative myocardial infarction. Ambulatory electrocardiographic monitoring solutions for continuous postoperative ischemia detection are warranted in the surgical ward.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Pettilä, Ville Yrjö Olavi


600 Technology > 610 Medicine & health








Mirella Aeberhard

Date Deposited:

02 Mar 2017 10:42

Last Modified:

12 Jul 2017 01:35

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Holter electrocardiography; cardiac ischemia; high-sensitive troponin T; myocardial infarction; perioperative complications; postoperative monitoring; vascular surgery




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