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Clinical Decisionmaking

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Immediate postoperative ECG helps identify non-cardiac surgery patients at risk for cardiac complications

Current guidelines recommend a postoperative electrocardiogram (ECG) to monitor patients who have undergone major noncardiac surgery and are at relatively high risk of developing postoperative cardiac complications. These usually are patients who have known or suspected coronary artery disease. However, an immediate postoperative ECG is useful in identifying even low-risk patients who warrant closer observation, according to findings from a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS06573). The study was led by Stephane Rinfret, M.D., M.Sc., of the University of Montreal, Quebec, and included researchers from San Francisco and Boston in the United States, and from the Hospital of Porto Alegre in Brazil.

The researchers recommend that clinicians perform a routine early postoperative ECG after major noncardiac surgery in adults 50 years or older, regardless of the patients' preoperative cardiac risk. They prospectively studied 3,570 patients who underwent major noncardiac procedures at a single hospital and had ECGs performed in the recovery room.

Regardless of patients' preoperative cardiac risk (based on the Revised Cardiac Risk Index), rates of major cardiac complications (heart attack, pulmonary edema, ventricular fibrillation or primary cardiac arrest, and complete heart block) were higher in patients who had new postoperative ECG abnormalities consistent with blocked blood flow to the heart (ischemia) compared with those who did not have ischemia (6.7 vs. 1.9 percent).

After adjusting for pre- and intraoperative clinical data, the presence of ischemia on the immediate postoperative ECG doubled the risk of major cardiac complications. When patients were stratified by a preoperative Revised Cardiac Risk Index, ischemia on the immediate postoperative ECG identified patients with higher risk of major cardiac complications in both low- and high-risk subsets.

For more information, see "Value of immediate postoperative electrocardiogram to update risk stratification after major noncardiac surgery," by Dr. Rinfret, Lee Goldman, M.D., M.P.H., Carisi A. Polanczyk, M.D., Sc.D., and others, in the October 15, 2004, American Journal of Cardiology 94, pp. 1017-1022.

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