Kirwin J D, Ascer E, Gennaro M, Mohan C, Jonas S, Yorkovich W, Matano R
Division of Vascular Surgery, Maimonides Medical Center, State University of New York, New York.
Ann Vasc Surg. 1993 Jan;7(1):27-32. doi: 10.1007/BF02042656.
Continuous ambulatory ECG (CAECG) monitoring has been advocated as an effective low-cost preoperative method for detecting silent myocardial ischemia in patients undergoing peripheral vascular surgery. In addition, silent ischemic events are associated with an increased incidence of postoperative myocardial infarctions. Ninety-six patients (mean age 73 years) admitted for elective aortic (24) or infrainguinal (72) operations over a 2-year period underwent 24-hour two- or three-lead CAECG monitoring. Results were reviewed by a single cardiologist blinded to the study. The criterion for ischemia was ST segment depressions of 1 mm or greater for 40 seconds or more 60 msec after the J point. Postoperative myocardial infarction was determined by ECG changes and/or elevated serum creatinine phosphokinase with positive MB isoenzymes. Risk factors included hypertension (71%), history of coronary artery disease (66%), smoking (61%), and diabetes mellitus (47%). Nine out of 96 patients (9.4%) had a positive CAECG test for silent myocardial ischemia. Only one patient (11.1%) developed postoperative myocardial infarction and there were no deaths in this group. The incidence of postoperative myocardial infarction in the nonischemic group was 16.1% (14/87). However, the mortality in this group was 6.9% (6/87). New and malignant arrhythmias requiring preoperative medical intervention were observed in seven patients (7.4%): two cases of ventricular tachycardia and five cases of atrial flutter/fibrillation. Contrary to previous reports, CAECG monitoring for silent ischemia was not a significant predictor of postoperative myocardial infarction or mortality in our patient population. However, we continue to recommend the preoperative use of CAECG monitoring as a diagnostic tool for unsuspected malignant arrhythmias.
动态心电图（CAECG）监测已被提倡作为一种有效的低成本术前检测方法，用于检测接受外周血管手术患者的无症状心肌缺血。此外，无症状缺血事件与术后心肌梗死的发生率增加有关。在两年期间，96例（平均年龄73岁）因择期主动脉手术（24例）或腹股沟下手术（72例）入院的患者接受了24小时双导联或三导联CAECG监测。结果由一位对该研究不知情的心脏病专家进行审查。缺血的标准为J点后60毫秒ST段压低1毫米或更多，持续40秒或更长时间。术后心肌梗死通过心电图变化和/或血清肌酐磷酸激酶升高伴MB同工酶阳性来确定。危险因素包括高血压（71%）、冠状动脉疾病史（66%）、吸烟（61%）和糖尿病（47%）。96例患者中有9例（9.4%）CAECG检测无症状心肌缺血呈阳性。只有1例患者（11.1%）发生了术后心肌梗死，该组无死亡病例。非缺血组术后心肌梗死的发生率为16.1%（14/87）。然而，该组的死亡率为6.9%（6/87）。7例患者（7.4%）观察到需要术前药物干预的新发和恶性心律失常：2例室性心动过速和5例心房扑动/颤动。与先前的报告相反，在我们的患者群体中，CAECG监测无症状缺血并非术后心肌梗死或死亡率的重要预测指标。然而，我们继续推荐术前使用CAECG监测作为未被怀疑的恶性心律失常的诊断工具。
