Systematic Review of the Role of New ECG Changes in Predicting Major Cardiac Events after Non-Cardiac Surgeries

Abstract

An estimated number of 234 million adults undergo major non-cardiac surgeries annually worldwide. The elderly requires surgery approximately four times as often as the rest of the people. Millions of these patients will have a major cardiac event (cardiac death, nonfatal myocardial infarction [MI], nonfatal cardiac arrest) within 30 days after surgery. In patients who have or are at risk for coronary artery disease, the most significant risks are perioperative myocardial ischemia and nonfatal myocardial infarction. Postoperative ischemia, as defined by new ECG changes, was more common and more severe than preoperative and intraoperative ischemia especially during the first 2 days and was strongly associated with major cardiac events which makes it the most important predictor of these events after non-cardiac surgeries. Perioperative ECG monitoring for myocardial ischemia can identify patients at risk for these events, allowing early treatment of these patients in order to avoid devastating outcomes. Previous studies have shown this association between new ECG ischemic changes and major cardiac events after non-cardiac surgery. We therefore undertook a systematic review to address the role of new ECG changes in predicting major cardiac events after non-cardiac surgery.