SURGERY IN PATIENTS WITH CORONARY-ARTERY DISEASE - SILENT ISCHEMIA DURING TRANSURETHRAL RESECTION OF TUMORS OF PROSTATE OR BLADDER

Background: Asymptomatic episodes of myocardial ischemia in clinically stable patients seem to occur frequently and may hint at a worse prog nosis. Hypothesis: This study was undertaken to determine whether surg ical patients with coronary artery disease (CAD) have a higher risk of cardiac ischemia during the perioperative period compared with the la te postoperative period and compared with patients without CAD. Method s: In all, 14 patients with and 14 patients without CAD were examined by Holter monitoring during the perioperative and three days later dur ing the postoperative periods for the presence of ST-segment depressio n as a marker of silent myocardial ischemia. Results: While patients w ithout CAD did not show ST-segment depression, patients with CAD were found to have had 143 episodes of ST-segment depression, 49% in the pe rioperative and 51% in postoperative recordings. Conclusion: Though pa tients were asymptomatic with antianginal therapy, there were episodes of ST-segment depression indicating silent myocardial ischemia in pat ients with CAD. Surgical interventions such as transurethral resection of tumors of prostate or bladder did not produce an increase of ische mic burden registered by Holter monitoring.