Publication: Association between routine preoperative electrocardiogram (ECG) findings with perioperative ecg changes in noncardiac surgeries among low cardiac risk patients: A cross-sectional study
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Date
2020
Authors
Sharizal, Zulhilm
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Abstract
Background Preoperative ECG plays a big role in detecting any underlying myocardial pathology. Recent evidence also suggests for pre-operative ECG in patients with symptoms and at increased cardiac risk undergoing non-cardiac surgeries. However, to screen all patients especially those without symptoms with low cardiac risk might add burden to the burgeoning healthcare cost. Objective To determine the proportion of abnormal preoperative ECG in low cardiac risk patients aged 40 years and above and factors associated with it and its association with actual development of perioperative ECG abnormalities in patient undergoing non-cardiac surgery under general or regional anaesthesia. Method A cross-sectional study design was adopted in this research. A total of 406 subjects were recruited in this study. They were aged 40 years old and above, ASA 2 and below, NYHA class 2 and below as well as patient who had low Revised Cardiac Risk Index (RCRI) that were admitted for non-cardiac surgeries in HUSM. Study sample were selected by convenient sampling. Preoperative ECG was done during routine preoperative anaesthetic assessment. Subsequent ECG assessments were done at 1) after induction of anaesthesia, 2) any changes in the cardiac monitoring, 3) one hour post-extubation period. ECG abnormalities include axis deviation, atrial fibrillation, bundle branch block, left ventricular hypertrophy, premature ventricular complexes more than 6 beats per minutes, Q wave, S-T segment changes, sinus tachycardia or bradycardia,supraventricular tachycardia, ventricular tachycardia and ventricular fibrillations. All ECG diagnoses were done by cardiologist following the recommendation by AHA/ACCF/HRS. Multiple logistic regression was used to determine the association between preoperative ECG findings and new or worsening perioperative ECG changes. Result A total of 132 patients (32.5%) had abnormal preoperative ECG and of this abnormal preoperative ECG, 53 patients (40.2%) experienced new or worsening ECG perioperatively. Factors associated with abnormal preoperative ECG were 1) Age (RR=1.02, 95%CI 1.01,1.03, P<0.001), 2) Male (RR=1.41, 95%CI 1.13,1.77, P<0.05), 3) Smoker (RR=1.62, 95%CI 1.04,2.52, P<0.05), 4) Hypertension (RR=1.28, 95%CI 1.01,1.62, P<0.05). Patients who had abnormal preoperative ECG changes were associated with higher incidence of developing new or worsening ECG perioperatively than patients with normal preoperative ECG findings (40.2 % vs 14.2 %, χ2(df)= 34.15(1), p=<0.001). The most common ECG findings were Left axis deviation (Preoperative, n=69 (17%), Perioperative, n=71 (17.5%)) and T Wave inversion (Preoperative, n=44 (10.8%), Perioperative, n=53 (13.1%)). After adjusting for covariates, the odds of developing new or worsening perioperative ECG were found to be higher in patients who had abnormal preoperative ECG findings (OR:4.41, 95%CI 2.62,7.39, p<0.001) and lower intraoperative heart rate (OR:2.71, 95%CI 1.55,2.74, p<0.001). Among patients with abnormal preoperative ECG findings, the most common new ECG findings during intraoperative and postoperative was sinus bradycardia, 16 patients (13.5%) and 20 patients (16.8%) respectively Conclusion Proportion of abnormal ECG in low cardiac risk patient age 50 and above is considerably significant. Those with abnormal preoperative ECG were significantly associated with new or worsening perioperative ECG abnormalities
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Keywords
Electrocardiogram , Low cardiac risk