Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery

BACKGROUND

The current European guidelines recommend that preoperative electrocardiogram (ECG) should be performed routinely in patients scheduled for high-risk surgery. However, the evidence regarding ECG as a predictor of perioperative cardiac complications is weak.

AIM

To evaluate association of preoperative ECG with short- and long-term outcomes in patients undergoing high-risk vascular procedures.

METHODS

This was a substudy of the international Vascular events In noncardiac Surgery patIents cohort evaluatioN (VISION) Study and included consecutive patients undergoing vascular procedures in a single tertiary center. In each patient a preoperative 12-lead ECG was evaluated in accordance with the Polish Cardiac Society recommendation by two experienced clinicians. We performed routine perioperative troponin monitoring in five time points (one preoperative and four postoperative measurements) to evaluate whether preoperative ECG abnormalities are associated with myocardial injury after noncardiac surgery (MINS) and 1-year major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction and stroke.

RESULTS

Study group comprised 348 patients, 80.5% of whom were male and the median age (interquartile range [IQR]) was 65 (59-72) years. The incidence of MINS and 1-year MACE was 18.7% and 14.4%, respectively. A multivariable analysis showed that none of the predefined ECG abnormalities (ST depression, left axis deviation, atrial fibrillation and bundle branch block) was associated with the incidence of MINS or 1-year MACE.

CONCLUSION

This study confirmed that preoperative ECG abnormalities are frequent in patients undergoing high-risk vascular surgery. However, we did not find evidence supporting relation between preoperative ECG abnormalities and postoperative adverse cardiac outcomes in high risk patients.

Effect of short-term fluctuations in outdoor air pollution on the number of hospital admissions due to acute myocardial infarction among inhabitants of Kraków, Poland

INTRODUCTION Air pollution is reaching alarming proportions worldwide; however, previous studies concerning the association between air pollution and myocardial infarction (MI) provided conflicting results. OBJECTIVES We evaluated a relationship between short‑term fluctuations in outdoor particulate matter (PM) and nitrogen dioxide (NO2) levels and the number of hospitalizations due to MI among the inhabitants of Kraków, Poland. PATIENTS AND METHODS Data on hospitalizations, daily pollutant concentrations, infections, and meteorological parameters were collected from December 2012 to September 2015. Data were assessed using a time‑series regression analysis with a distributed lag model. RESULTS An increase of 10 μg/m3 in PM2.5 levels was associated with a higher risk of hospital admission due to MI (odds ratio [OR], 1.32; 95% CI, 1.01-1.40; P = 0.0002). For PM10 the effect was observed only with a simultaneous decrease of 1ºC in the mean daily temperature (OR, 1.08; 95% CI, 1.01-1.17; P = 0.03). Significant effects were observed at lags 5 and 6. The effect of NO2 was significant at lags 0 and 1, but only in patients aged 70 years or older (OR, 1.13; 95% CI, 1.01-1.23; P = 0.007) and those with pulmonary disorders (OR, 1.12; 95% CI, 1.01-1.31; P = 0.01). CONCLUSIONS In all age groups, the short‑term elevation in PM2.5 levels was associated with an increased number of daily hospital admissions for MI, whereas for PM10 the effect was significant only with a simultaneous decrease in temperature. The effect of NO2 was observed only in older individuals and patients with pulmonary disorders. A negative clinical effect was more delayed in time in the case of exposure to PM than to NO2.

The impact of weather factors, moon phases, and seasons on abdominal aortic aneurysm rupture

BACKGROUND

Several studies have documented that weather factors, seasons of the year, time of the day, and even changes in moon phases have an impact on the occurrence of rupture of an abdominal aortic aneurysm (RAAA); however, the available data are confounding. The objective of this study was to determine the impact of these factors on the prevalence and mortality rate of RAAA.

METHODS

This is a retrospective analysis of medical records of patients treated for RAAA over a 10-year period. Weather data (i.e., atmospheric pressure, air temperature, humidity, visibility, and wind speed) and weather events (i.e., rain, snow, and storms, etc) were obtained from the local meteorologic weather station and analyzed for a correlation with RAAA.

RESULTS

Five hundred thirty patients with RAAA were identified, and these patients presented on 478 days during the 10-year study period (3,652 days), with the overall in-hospital mortality rate of 48.7%. The RAAA mortality was higher during weekends and national holidays, when compared to weekdays (59% vs 45%; P = 0.006) and in patients admitted between 3-7 am when compared to work day hours (65.5% vs 44.1%; P = 0.035). Season changes had no influence on the frequency of RAAA; however, summer seemed to be associated with an increase in mortality as opposed to autumn (54.4% vs 42.5%; P = 0.047). Mean atmospheric pressure (and fluctuations thereof) and other weather factors, including phases and parts of the moon, did not correlate with RAAA occurrence or its mortality.

CONCLUSIONS

Patients with RAAA who were admitted on weekends, national holidays and in late night hours had lower survival rates. Weather factors (including atmospheric pressure) do not influence the prevalence and mortality of RAAA.