Usefulness of computer-assisted ECG analysis in the pre-operative evaluation of noncardiac surgery

ANCOR SANZ-GARCıA; ALBERTO CECCONI; ENRIQUE ALDAY; MAURIZIO CECCONI; JESUS GARRIDO; JUAN M.C. MORENO; ANTONIO PLANAS; FERNANDO ALFONSO; GUILLERMO J. ORTEGA; LUIS J. JIMENEZ-BORREGUERO

EUROPEAN JOURNAL OF ANAESTHESIOLOGY

LIPPINCOTT WILLIAMS & WILKINS

Lugar: Philadelphia; Año: 2020

0265-0215

IMPORTANCE: Major noncardiac surgery is associated with major cardiovascular complications and all-cause mortality. Despite being commonly recorded in preoperative cardiac evaluation, the prognostic value of the ECG is still unclear. This may be related to the fact that the ECG analysis is mainly based on the visual detection of classic patterns omitting most of the quantitative information. Computer-assisted evaluation of ECG measures may disclose new risk markers for major noncardiac surgery and all-cause mortality.OBJECTIVE: To increase the risk prediction in adults undergoing elective major noncardiac surgery by identifying new ECG biomarkers.DESIGN Prospective cohort study.SETTING Enrolment was undertaken at a university hospital from October 2011 to July 2013.PARTICIPANTS 242 patients undergoing major noncardiac surgery.EXPOSURE Adults with cardiovascular risk factors who underwent noncardiac elective surgery.MAIN OUTCOMES AND MEASURES The primary composite endpoint of this study was cardiovascular complications and all-cause mortality, comprising: death from all causes (except those clearly associated with the surgery procedure), resuscitated cardiac arrest, stroke, exacerbation of CHF, and acute coronary syndrome.METHODS Patients undergoing major noncardiac surgery were prospectively recruited in the study. A total of 37 morphological ECG measures were automatically quantified for each single lead (444 morphological values per patient) using an automated ECG analysis algorithm. The main outcome measure was the relationship between ECG biomarkers and major complications during the first thirty days after major non-cardiac surgery. A multivariate logistic regression analysis was performed.RESULTS Duration of the negative component of P wave in V1 (OR 4.96; IC95%: 1.51 ? 16.36), area of QRS in V5 (OR 4.3; IC95%: 1.27 ? 14.7) and negative values of ST segment offset in V4 (OR 9.4; IC95%: 1.8 ? 68.1) were detected as independent risk factors for major complications.CONCLUSIONS AND RELEVANCE Detection in preoperative ECG of a prolonged negative component of the P wave in V1, a larger QRS area in V5 or ST segment depression in V4 identifies patients at high risk of cardiac complications and mortality after major noncardiac surgery.