Perioperative myocardial ischemia: Its relation to anatomic pattern of coronary artery stenosis

C. W. Hogue, T. J. Herbst, C. Pond, I. Apostolidou, D. G. Lappas

Research output: Contribution to journalArticle

Abstract

Background: Recently, the frequency of intraoperative myocardial ischemic episodes in patients with steal-prone coronary anatomy, compared with other groups of patients undergoing coronary artery surgery (CABG), has been characterized. Because the relationship between anatomic distribution of coronary stenosis and myocardial ischemic episodes over the entire perioperative period has not been well defined, the authors sought to examine this relationship in 100 adult patients undergoing CABG surgery. Methods: Continuous electrocardiographic (ECG) monitoring was performed in the pre-, intra-, and postoperative periods, quantifying the frequency (episodes/hour of monitoring [epis/h]) and duration (minutes/hour of monitoring [min/h]) of ECG ischemic episodes defined as a reversible ST segment shift ≥ 1 mm at J + 60 ms of ≥ 1 min duration. Based on preoperative coronary angiography, patients were categorized into the following groups: group 1 (n = 40), steal- prone coronary anatomy (occluded major coronary artery and ≥ 50% stenosis of the artery supplying the collateral vessels); group 2 (n = 17), left main or equivalent coronary stenosis (≥ 50% stenosis of left main coronary artery or ≥ 70% proximal stenosis of the left anterior descending and circumflex coronary arteries); and group 3 (n = 43), coronary artery stenosis ≥ 70% not fitting the preceding categories. Results: Compared with group 3, patients in group 1 had more frequent and longer ECG ischemic events preoperatively, and were nearly two times more likely (relative risk 1.82, 95% confidence interval 1.07-3.10) to develop an ischemic event during this period. There were no differences in the relative risk, frequency, or duration of an ischemic episode between groups 1 and 3 during the intraoperative and postoperative periods, or between groups 1 and 2 or groups 2 and 3 during any perioperative period. In group 2 patients, the frequency of ischemic epis/h was less intra- compared with preoperatively, while, in group 3, the ischemic epis/h decreased postoperatively compared with the intraoperative period. The duration of ischemic episodes (min/h) in group 3, however, increased postoperatively compared with the pre- and intraoperative periods, while, in group 2, the duration of ischemic episodes (min/h) was less intraoperatively compared with the preoperative period. Ninety-seven percent of preoperative ECG ischemic episodes occurred without symptoms. Postoperative myocardial infarction occurred in three patients in group 3, two in group 2, and one in group 1. There were no perioperative deaths. Conclusion: These data indicate that, compared with patients with non-left main or equivalent coronary stenosis, those with steal-prone coronary anatomy have more frequent and longer ECG ischemic episodes preoperatively. The data also indicate that there are no other differences in the risk, frequency, or duration of ischemic episodes between groups perioperatively. Thus, different distributions of coronary artery stenosis may be associated with changes in the perioperative characteristics of ECG ischemic episodes.

Original languageEnglish (US)
Pages (from-to)514-524
Number of pages11
JournalAnesthesiology
Volume79
Issue number3
StatePublished - 1993
Externally publishedYes

Fingerprint

Coronary Stenosis
Myocardial Ischemia
Intraoperative Period
Preoperative Period
Anatomy
Coronary Vessels
Perioperative Period
Postoperative Period
Pathologic Constriction
Coronary Angiography
Arteries
Myocardial Infarction
Confidence Intervals

Keywords

  • Anesthesia: cardiac
  • Heart: coronary artery disease; myocardial ischemia
  • Monitoring: Holter electrocardiography
  • Surgery, cardiac: coronary artery bypass graft

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Hogue, C. W., Herbst, T. J., Pond, C., Apostolidou, I., & Lappas, D. G. (1993). Perioperative myocardial ischemia: Its relation to anatomic pattern of coronary artery stenosis. Anesthesiology, 79(3), 514-524.

Perioperative myocardial ischemia : Its relation to anatomic pattern of coronary artery stenosis. / Hogue, C. W.; Herbst, T. J.; Pond, C.; Apostolidou, I.; Lappas, D. G.

In: Anesthesiology, Vol. 79, No. 3, 1993, p. 514-524.

Research output: Contribution to journalArticle

Hogue, CW, Herbst, TJ, Pond, C, Apostolidou, I & Lappas, DG 1993, 'Perioperative myocardial ischemia: Its relation to anatomic pattern of coronary artery stenosis', Anesthesiology, vol. 79, no. 3, pp. 514-524.
Hogue CW, Herbst TJ, Pond C, Apostolidou I, Lappas DG. Perioperative myocardial ischemia: Its relation to anatomic pattern of coronary artery stenosis. Anesthesiology. 1993;79(3):514-524.
Hogue, C. W. ; Herbst, T. J. ; Pond, C. ; Apostolidou, I. ; Lappas, D. G. / Perioperative myocardial ischemia : Its relation to anatomic pattern of coronary artery stenosis. In: Anesthesiology. 1993 ; Vol. 79, No. 3. pp. 514-524.
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abstract = "Background: Recently, the frequency of intraoperative myocardial ischemic episodes in patients with steal-prone coronary anatomy, compared with other groups of patients undergoing coronary artery surgery (CABG), has been characterized. Because the relationship between anatomic distribution of coronary stenosis and myocardial ischemic episodes over the entire perioperative period has not been well defined, the authors sought to examine this relationship in 100 adult patients undergoing CABG surgery. Methods: Continuous electrocardiographic (ECG) monitoring was performed in the pre-, intra-, and postoperative periods, quantifying the frequency (episodes/hour of monitoring [epis/h]) and duration (minutes/hour of monitoring [min/h]) of ECG ischemic episodes defined as a reversible ST segment shift ≥ 1 mm at J + 60 ms of ≥ 1 min duration. Based on preoperative coronary angiography, patients were categorized into the following groups: group 1 (n = 40), steal- prone coronary anatomy (occluded major coronary artery and ≥ 50{\%} stenosis of the artery supplying the collateral vessels); group 2 (n = 17), left main or equivalent coronary stenosis (≥ 50{\%} stenosis of left main coronary artery or ≥ 70{\%} proximal stenosis of the left anterior descending and circumflex coronary arteries); and group 3 (n = 43), coronary artery stenosis ≥ 70{\%} not fitting the preceding categories. Results: Compared with group 3, patients in group 1 had more frequent and longer ECG ischemic events preoperatively, and were nearly two times more likely (relative risk 1.82, 95{\%} confidence interval 1.07-3.10) to develop an ischemic event during this period. There were no differences in the relative risk, frequency, or duration of an ischemic episode between groups 1 and 3 during the intraoperative and postoperative periods, or between groups 1 and 2 or groups 2 and 3 during any perioperative period. In group 2 patients, the frequency of ischemic epis/h was less intra- compared with preoperatively, while, in group 3, the ischemic epis/h decreased postoperatively compared with the intraoperative period. The duration of ischemic episodes (min/h) in group 3, however, increased postoperatively compared with the pre- and intraoperative periods, while, in group 2, the duration of ischemic episodes (min/h) was less intraoperatively compared with the preoperative period. Ninety-seven percent of preoperative ECG ischemic episodes occurred without symptoms. Postoperative myocardial infarction occurred in three patients in group 3, two in group 2, and one in group 1. There were no perioperative deaths. Conclusion: These data indicate that, compared with patients with non-left main or equivalent coronary stenosis, those with steal-prone coronary anatomy have more frequent and longer ECG ischemic episodes preoperatively. The data also indicate that there are no other differences in the risk, frequency, or duration of ischemic episodes between groups perioperatively. Thus, different distributions of coronary artery stenosis may be associated with changes in the perioperative characteristics of ECG ischemic episodes.",
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T1 - Perioperative myocardial ischemia

T2 - Its relation to anatomic pattern of coronary artery stenosis

AU - Hogue, C. W.

AU - Herbst, T. J.

AU - Pond, C.

AU - Apostolidou, I.

AU - Lappas, D. G.

PY - 1993

Y1 - 1993

N2 - Background: Recently, the frequency of intraoperative myocardial ischemic episodes in patients with steal-prone coronary anatomy, compared with other groups of patients undergoing coronary artery surgery (CABG), has been characterized. Because the relationship between anatomic distribution of coronary stenosis and myocardial ischemic episodes over the entire perioperative period has not been well defined, the authors sought to examine this relationship in 100 adult patients undergoing CABG surgery. Methods: Continuous electrocardiographic (ECG) monitoring was performed in the pre-, intra-, and postoperative periods, quantifying the frequency (episodes/hour of monitoring [epis/h]) and duration (minutes/hour of monitoring [min/h]) of ECG ischemic episodes defined as a reversible ST segment shift ≥ 1 mm at J + 60 ms of ≥ 1 min duration. Based on preoperative coronary angiography, patients were categorized into the following groups: group 1 (n = 40), steal- prone coronary anatomy (occluded major coronary artery and ≥ 50% stenosis of the artery supplying the collateral vessels); group 2 (n = 17), left main or equivalent coronary stenosis (≥ 50% stenosis of left main coronary artery or ≥ 70% proximal stenosis of the left anterior descending and circumflex coronary arteries); and group 3 (n = 43), coronary artery stenosis ≥ 70% not fitting the preceding categories. Results: Compared with group 3, patients in group 1 had more frequent and longer ECG ischemic events preoperatively, and were nearly two times more likely (relative risk 1.82, 95% confidence interval 1.07-3.10) to develop an ischemic event during this period. There were no differences in the relative risk, frequency, or duration of an ischemic episode between groups 1 and 3 during the intraoperative and postoperative periods, or between groups 1 and 2 or groups 2 and 3 during any perioperative period. In group 2 patients, the frequency of ischemic epis/h was less intra- compared with preoperatively, while, in group 3, the ischemic epis/h decreased postoperatively compared with the intraoperative period. The duration of ischemic episodes (min/h) in group 3, however, increased postoperatively compared with the pre- and intraoperative periods, while, in group 2, the duration of ischemic episodes (min/h) was less intraoperatively compared with the preoperative period. Ninety-seven percent of preoperative ECG ischemic episodes occurred without symptoms. Postoperative myocardial infarction occurred in three patients in group 3, two in group 2, and one in group 1. There were no perioperative deaths. Conclusion: These data indicate that, compared with patients with non-left main or equivalent coronary stenosis, those with steal-prone coronary anatomy have more frequent and longer ECG ischemic episodes preoperatively. The data also indicate that there are no other differences in the risk, frequency, or duration of ischemic episodes between groups perioperatively. Thus, different distributions of coronary artery stenosis may be associated with changes in the perioperative characteristics of ECG ischemic episodes.

AB - Background: Recently, the frequency of intraoperative myocardial ischemic episodes in patients with steal-prone coronary anatomy, compared with other groups of patients undergoing coronary artery surgery (CABG), has been characterized. Because the relationship between anatomic distribution of coronary stenosis and myocardial ischemic episodes over the entire perioperative period has not been well defined, the authors sought to examine this relationship in 100 adult patients undergoing CABG surgery. Methods: Continuous electrocardiographic (ECG) monitoring was performed in the pre-, intra-, and postoperative periods, quantifying the frequency (episodes/hour of monitoring [epis/h]) and duration (minutes/hour of monitoring [min/h]) of ECG ischemic episodes defined as a reversible ST segment shift ≥ 1 mm at J + 60 ms of ≥ 1 min duration. Based on preoperative coronary angiography, patients were categorized into the following groups: group 1 (n = 40), steal- prone coronary anatomy (occluded major coronary artery and ≥ 50% stenosis of the artery supplying the collateral vessels); group 2 (n = 17), left main or equivalent coronary stenosis (≥ 50% stenosis of left main coronary artery or ≥ 70% proximal stenosis of the left anterior descending and circumflex coronary arteries); and group 3 (n = 43), coronary artery stenosis ≥ 70% not fitting the preceding categories. Results: Compared with group 3, patients in group 1 had more frequent and longer ECG ischemic events preoperatively, and were nearly two times more likely (relative risk 1.82, 95% confidence interval 1.07-3.10) to develop an ischemic event during this period. There were no differences in the relative risk, frequency, or duration of an ischemic episode between groups 1 and 3 during the intraoperative and postoperative periods, or between groups 1 and 2 or groups 2 and 3 during any perioperative period. In group 2 patients, the frequency of ischemic epis/h was less intra- compared with preoperatively, while, in group 3, the ischemic epis/h decreased postoperatively compared with the intraoperative period. The duration of ischemic episodes (min/h) in group 3, however, increased postoperatively compared with the pre- and intraoperative periods, while, in group 2, the duration of ischemic episodes (min/h) was less intraoperatively compared with the preoperative period. Ninety-seven percent of preoperative ECG ischemic episodes occurred without symptoms. Postoperative myocardial infarction occurred in three patients in group 3, two in group 2, and one in group 1. There were no perioperative deaths. Conclusion: These data indicate that, compared with patients with non-left main or equivalent coronary stenosis, those with steal-prone coronary anatomy have more frequent and longer ECG ischemic episodes preoperatively. The data also indicate that there are no other differences in the risk, frequency, or duration of ischemic episodes between groups perioperatively. Thus, different distributions of coronary artery stenosis may be associated with changes in the perioperative characteristics of ECG ischemic episodes.

KW - Anesthesia: cardiac

KW - Heart: coronary artery disease; myocardial ischemia

KW - Monitoring: Holter electrocardiography

KW - Surgery, cardiac: coronary artery bypass graft

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