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      Preoperative Silent Myocardial Ischemia Has It Prognostic Significance?

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          We studied the prognostic significance of preoperative silent myocardial ischemia in patients undergoing coronary artery bypass grafting (CABG). Nonfatal and fatal perioperative myocardial infarction were regarded as prognostically important endpoints. Ninety-five patients (9 women) with stable-effort angina pectoris were studied during their hospital stay in the surgery ward before CABG. Silent ischemia was detected using Holter monitoring; all patients had Holter monitoring 76 ± 9 h before surgery using Marguette Laser Holter and Cardiodata Prodigy systems. Two-channel electrocardiographic recordings were used which included CM<sub>5</sub> and a modified inferior lead. Effort was taken to avoid leads with pathological Q waves and resting ST segment abnormalities. The mean duration of the monitoring was 27.9 ± 11.3 h. Three patients (3.2%) had angina pectoris during these observations, 1 of them with significant ST depression. Silent ST depression was found in 12 patients (12.6%). Twelve patients (12.6%) had perioperative myocardial infarction. Perioperative myocardial infarction was more common in patients with silent ischemia: 4/12 vs. 8/83; χ<sup>2</sup> = 4.48955, p = 0.0341. Our results suggest that Holter monitoring identifies a group of patients with a higher probability of perioperative myocardial infarction. In the future, it may be possible to study different methods to prevent this surgical complication.

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          Author and article information

          S. Karger AG
          12 November 2008
          : 78
          : 2
          : 95-98
          aJános Municipal Hospital III, Internal Department and Cardiology; Hungarian Institute of Cardiology, Department of bCardiology and cSurgery, Budapest, Hungary
          174772 Cardiology 1991;78:95–98
          © 1991 S. Karger AG, Basel

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          Pages: 4
          General Cardiology


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