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Suba S, Carey MG, Pelter MM. Occurrence of Transient Myocardial Ischemic Events Among Non-ST Segment Elevation Acute Coronary Syndrome Patients Before or After Invasive Coronary Angiography. Crit Pathw Cardiol 2024; 23:131-136. [PMID: 38578970 PMCID: PMC11341255 DOI: 10.1097/hpc.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND The occurrence of transient myocardial ischemia (TMI) is an important pathology in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), yet studies are scarce regarding when TMI occurs during hospitalization, particularly in relation to invasive coronary angiography (ICA). This study examined: (1) TMI before or after ICA; (2) patient characteristics and ischemic burden by TMI group (before or after ICA); and (3) major in-hospital complications (transfer to critical care, death) and length of stay by TMI group (before or after ICA). METHODS Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic Holter. Patient records were reviewed to assess ischemic burden [TMI time (min) ÷ hours recording duration], outcomes, and TMI timing, before or after ICA. RESULTS In 38 patients, 3 (8%) had TMI before and after ICA. Of the remaining 35 patients (92%), TMI occurred before ICA (16; 46%), and after ICA (9; 26%), and 10 (28%) did not have ICA. Patient characteristics, untoward outcomes, and TMI duration (minutes) did not differ by group. Ischemic burden was higher in patients with TMI after ICA (7.29 ± 8.82 min/h) compared to before ICA (2.54 ± 2.11 min/h), P = 0.039. Hospital length of stay by TMI group was 113 ± 113 (before), 226 ± 244 (after), and 85 ± 65 hours (no ICA); P = 0.172. CONCLUSIONS Almost half of the sample had TMI before ICA; one-third had TMI but did not have ICA. Patients with TMI after an ICA had a higher ischemic burden. Future studies with larger sample sizes are needed to investigate further the short- and long-term clinical significance of TMI among NSTE-ACS patients.
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Affiliation(s)
- Sukardi Suba
- From the School of Nursing, University of Rochester, Rochester, NY
| | - Mary G Carey
- From the School of Nursing, University of Rochester, Rochester, NY
| | - Michele M Pelter
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA
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Zhu Q, Duan H, Liu Z, Li Y, Zhang Y, Shen L, Huang Y. The incidence and risk factors of perioperative cardiac complications in noncardiac major surgery in high-altitude areas: A prospective trial in Tibet autonomous region, China. Front Cardiovasc Med 2023; 10:1158711. [PMID: 37077733 PMCID: PMC10106712 DOI: 10.3389/fcvm.2023.1158711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundThe risk of perioperative cardiac complications (PCCs) in patients living in high-altitude areas may increase with more adverse clinical outcomes due to the special geographical environment, which has not yet been studied. We aimed to determine the incidence and analyze risk factors for PCCs in adult patients undergoing major noncardiac surgery in the Tibet Autonomous Region.MethodsThis prospective cohort study enrolled resident patients from high-altitude areas receiving major noncardiac surgery in Tibet Autonomous Region People's Hospital in China. Perioperative clinical data were collected, and the patients were followed up until 30 days after surgery. The primary outcome was PCCs during the operation and within 30 days after the surgery. Logistic regression was used to build the prediction models for PCCs. A receiver operating characteristic (ROC) curve was used to evaluate the discrimination. A prognostic nomogram was constructed to generate a numerical probability of PCCs for patients undergoing noncardiac surgery in high-altitude areas.ResultsAmong the 196 patients living in high-altitude areas involved in this study, 33 (16.8%) suffered PCCs perioperatively and within 30 days after surgery. Eight clinical factors were identified in the prediction model, including older age (P = 0.028), extremely high altitude above 4,000 m (P = 0.442), preoperative metabolic equivalent (MET) < 4 (P = 0.153), history of angina within 6 months (P = 0.037), history of great vascular disease (P = 0.073), increased preoperative high sensitivity C-reactive protein (hs-CRP) (P = 0.072), intraoperative hypoxemia (P = 0.025) and operation time >3 h (P = 0.043). The area under the curve (AUC) was 0.766 (95% confidence interval: 0.785–0.697). The score calculated from the prognostic nomogram predicted the risk of PCCs in high-altitude areas.ConclusionThe incidence of PCCs in resident patients living in high-altitude areas who underwent noncardiac surgery was high, and the risk factors included older age, high altitude above 4,000 m, preoperative MET < 4, history of angina within 6 months, history of great vascular disease, increased preoperative hs-CRP, intraoperative hypoxemia, and operation time >3 h. The prognostic nomogram of this study could help to assess the PCCs for patients in high-attitude areas undergoing noncardiac surgery.Clinical Trial RegistrationClinicalTrials.gov ID: NCT04819698.
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Affiliation(s)
- Qianmei Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanyu Duan
- Department of Anesthesiology, Tibet Autonomous Region People’s Hospital, Lhasa, China
| | - Zijia Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Correspondence: Zijia Liu Labaciren
| | - Yi Li
- Department of Anesthesiology, Tibet Autonomous Region People’s Hospital, Lhasa, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Effect of Mobile Internet on Attitude and Self-Efficacy of Patients with Coronary Heart Disease Diagnosed by 12-Lead Holter ECG. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3414178. [PMID: 35035823 PMCID: PMC8759848 DOI: 10.1155/2022/3414178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/22/2022]
Abstract
Objective To explore the effect of mobile Internet on attitude and self-efficacy of patients with coronary heart disease (CHD) diagnosed by 12-lead Holter ECG. Methods The clinical data of 62 patients with CHD who underwent routine ECG examination (control group I) and 12-lead dynamic electrocardiogram (control group II) in our hospital (June 2017–December 2020) were retrospectively analyzed, and the clinical data of another 62 patients with CHD who received 12-lead Holter ECG examination combined with mobile Internet in our hospital at the same time (study group) were retrospectively analyzed. The clinical observation indexes of the three groups were compared. Results No obvious difference in general data among groups (P > 0.05). Compared with the control group I, the positive detection rate (PDR) of the study group and the control group II was obviously higher (P < 0.05), and the PDR of the study group was obviously higher than that of the control group II, without remarkable difference between both groups (P > 0.05). Compared with the control group, the scores of CAS-R of the study group were obviously higher (P < 0.05), and self-efficacy of daily life, health behaviors, medication compliance, and compliance behavior of the study group was obviously better (P < 0.05). The diagnostic efficacy was derived by ROC curve analysis, 12-lead Holter ECG combined with mobile Internet + routine ECG > 12-lead Holter ECG combined with mobile Internet > 12-lead Holter ECG > routine ECG. Conclusion Compared with the routine ECG, the sensitivity of 12-lead Holter ECG in the diagnosis of CHD is conspicuously higher. Meanwhile, 12-lead Holter ECG combined with mobile Internet can enhance the diagnostic efficiency and improve patients' perceived control attitude and self-efficacy.
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Abstract
Remarkable progress has been seen in monitoring systems using noninvasive ambulatory electrocardiograms (ECGs). In the Holter ECG system, 12-channel formats have been utilized as diagnostic tools, particularly for the detection of transient or silent myocardial ischemia and dynamic electrical disorders. In patients diagnosed with cryptogenic stroke, despite negative results on standard ECG tests, continuous ambulatory ECG monitoring for up to 30 days has been shown to increase the detection rate of transient atrial fibrillation. At present, a waterproof Holter ECG system is available. Recently, continuous late potential measurements using the time domain method and frequency domain T-wave alternans using the spectral analysis method for 24 hours have been applied to the Holter ECG and developed as novel risk stratification markers. Wearable ECG monitors that are built into belts, vests, wristbands, adhesive patches, and mobile smartphones have been used as fitness products for athletes and healthcare products for the general population. In the future, such devices may be used as remote monitoring tools for the detection of arrhythmias.
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Affiliation(s)
- Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Japan
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Jee HS, Kim J, Lee SH, Ko JS, Gwak MS, Kim GS. Five-lead Electrocardiography During Living Donor Liver Transplantation: Incidence and Clinical Significance of ST Segment Abnormality. Transplant Proc 2020; 52:1784-1787. [PMID: 32505505 DOI: 10.1016/j.transproceed.2020.01.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/26/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Five-lead electrocardiography (ECG) is commonly used during liver transplantation, while 3-lead ECG is used during most noncardiac operations. This study aimed to evaluate the incidence and clinical significance of ST segment abnormality during living donor liver transplantation (LDLT) with 5-lead ECG. METHODS We retrospectively reviewed medical records of patients who received LDLT between May 2018 and May 2019. A total of 109 adult recipients underwent LDLT, and 108 recipients were divided into 2 groups according to whether or not significant ST segment abnormality had occurred at 8 predetermined time points during the operation. ST segment change by more than 1 mm was regarded as significant. RESULTS Of the 108 recipients, 21 recipients (19.4%) had significant ST segment depression during the operation. No case of significant ST segment elevation was noted. The significant ST segment depression was detected mostly in lead II and V5, and with 2 in combination we could detect 95.2% of significant ST segment change. The significant ST segment depression was frequently observed 1 hour after anhepatic phase and 2 hours after reperfusion. Patient characteristics were not different between the 2 groups. Moreover, the cardiac enzyme (troponin I) measurements, measured immediately after the operation, were not different between the 2 groups. CONCLUSIONS Although significant ST segment change was frequently observed during LDLT, more studies are required to determine the clinical significance of 5-lead ECG ST segment abnormality during LDLT.
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Affiliation(s)
- Hyeon Sook Jee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Yeung K, Eiberg JP, Kehlet H, Aasvang EK. Acute complications in the post-anaesthesia care unit after infrainguinal surgery for lower limb ischaemia - a prospective observational cohort study. VASA 2018; 48:89-97. [PMID: 30355274 DOI: 10.1024/0301-1526/a000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Arterial surgery for lower limb ischaemia is a frequently performed procedure in patients with severe cardio-pulmonary comorbidities, making them high-risk patients for acute postoperative complications with a need for prolonged stay in the post-anaesthesia care unit (PACU). However, detailed information on complications during the PACU stay is limited, hindering mechanism-based interventions for early enhanced recovery. Thus, we aimed to systematically describe acute complications and related risk factors in the immediate postoperative phase after infrainguinal arterial surgery. PATIENTS AND METHODS Patients transferred to the PACU after infrainguinal arterial surgery due to chronic or acute lower limb ischaemia were consecutively included in a six-month observational cohort study. Pre- and intraoperative data included comorbidities as well as surgical and anaesthetic technique. Data on complications and treatments in the PACU were collected every 15 minutes using a standardised assessment tool. The primary endpoint was occurrence of predefined moderate or severe complications occurring during PACU stay. RESULTS In total, 155 patients were included for analysis. Eighty (52 %) patients experienced episodes with oxygen desaturation (< 85 %) and moderate or severe pain occurred in 72 patients (47 %); however, circulatory complications (hypotension, tachycardia) were rare. Preoperative opioid use was a significant risk factor for moderate or severe pain in PACU (59 vs. 38 % chronic vs. opioid naïve patients (P = 0.01). CONCLUSIONS Complications in the PACU after infrainguinal arterial surgery relates to saturation and pain, suggesting that future efforts should focus on anaesthesia and analgesic techniques including opioid sparing regimes to enhance early postoperative recovery.
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Affiliation(s)
- Karin Yeung
- 1 Department of Anaesthesiology and Surgery, Rigshospitalet, University of Copenhagen, Denmark.,2 Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Jonas Peter Eiberg
- 2 Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark.,3 Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen Denmark
| | - Henrik Kehlet
- 4 Section for Surgical Pathophysiology, Rigshospitalet, University of Copgenhagen, Denmark
| | - Eske Kvanner Aasvang
- 1 Department of Anaesthesiology and Surgery, Rigshospitalet, University of Copenhagen, Denmark
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