THE CONCORDANCE OF INTRAOPERATIVE LEFT-VENTRICULAR WALL-MOTION ABNORMALITIES AND ELECTROCARDIOGRAPHIC S-T SEGMENT CHANGES - ASSOCIATION WITH OUTCOME AFTER CORONARY REVASCULARIZATION

Background: Transesophageal echocardiography (TEE) and Holter electroc ardiography (ECG) are used to detect intraoperative ischemia during co ronary artery bypass graft surgery (CABG). Concordance of these modali ties and sensitivity as indicators of adverse perioperative cardiac ou tcomes are poorly defined. The authors tried to determine whether rout ine use of Holter ECG and TEE in patients with CABGs has clinical valu e in identifying those patients in whom myocardial infarction (MI) is likely to develop. Methods: A total of 351 patients with CABG and both ECG- and TEE-evaluable data were examined for the occurrence of ische mia and infarction. The TEE and five-lead Holter ECGs were performed c ontinuously during cardiac surgery. The incidence of MI (creatine kina se-MB greater than or equal to 100 ng/ml) within 12 h of arrival in th e intensive care [ICU] unit, new ECG Q wave on ICU admission or on the morning of postoperative day 1, or both, were recorded. Results: Elec trocardiographic or TEE evidence of intraoperative ischemia was presen t in 126 (36%) patients. The concordance between modalities was poor ( positive concordance = 17%; Kappa statistic = 0.13). Myocardial infarc tion occurred in 62 (17%) patients, and 32 (52%) of them had previous intraoperative ischemia. Of these, 28 (88%) were identified by TEE, wh ereas 13 (41%) were identified by ECG. Prediction of MI was greater fo r TEE compared with ECG. Conclusions: Wall-motion abnormalities detect ed by TEE are more common than S-T segment changes detected by ECG, an d concordance between the two modalities is low. One half of patients with MI had preceding ECG or TEE ischemia. Logistic regression reveale d that TEE is twice as predictive as ECG in identifying patients who h ave MI.