Can J Cardiol. 2025 Sep 25:S0828-282X(25)01187-0. doi: 10.1016/j.cjca.2025.09.035. Online ahead of print.
ABSTRACT
BACKGROUND: The relationship between myocardial injury following cardiac surgery (MICS), ischemia on electrocardiogram (ECG) and mortality is uncertain. We aimed to determine if potential ischemic ECG changes after cardiac surgery are associated with 30-day mortality.
METHODS: In a cohort of adults who underwent cardiac surgery, experts interpreted pre-operative, post-operative days 0-1-2-3, and the last before discharge ECGs (total=59,539), for new potential ischemic ECG changes.
RESULTS: Among 12,594 patients, 9097 (72.2%) had potential ischemic ECG changes; 259 (2.1%) died within 30 days after surgery. Among patients with troponin elevation meeting MICS criteria, in models adjusting for EuroSCORE II, the hazard ratio (HR) for 30-day mortality was 0.57, 95%CI 0.35-0.94, p=0.03 for new Q waves; 2.17, 95%CI 1.14-4.13, p=0.02 for ST depression ≥2mm; and 0.58, 95%CI 0.39-0.87, p=0.007 for T wave inversion 1-1.9mm. ST elevation was not significantly associated with 30-day mortality. The only ECG change for which coronary artery bypass grafting (CABG) was an effect modifier was new left bundle branch block (LBBB): HR 2.78, 95%CI 1.69-4.60, p=0.0001 with CABG and HR 1.10, 95%CI 0.54-2.21, p=0.27 without CABG, interaction p=0.03.
CONCLUSION: After cardiac surgery, potential ischemic ECG changes are common and have divergent associations with mortality. ST depression was associated with a higher risk of death, while new Q waves and T wave inversions were associated with a lower risk of death. A new LBBB was associated with a higher risk of death only among patients who underwent CABG. Potential ischemic ECG changes are common after cardiac surgery and lack specificity for the diagnosis of myocardial infarction.
PMID:41015246 | DOI:10.1016/j.cjca.2025.09.035
Recent Comments