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Myocardial infarction after vascular surgery: the role of prolonged, stress-induced, ST depression-type ischemia

Giora Landesberg, MD, DSc^*, Morris Mosseri, MD, Doron Zahger, MD, Yehuda Wolf, MD, Misha Perouansky, MD^*, Haim Anner, MD, Benjamin Drenger, MD^*, Yonatan Hasin, MD, Yacov Berlatzky, MD and Charles Weissman, MD^*

^* Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel
Cardiology, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel
Vascular Surgery, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel
Coronary Care Unit, Hadassah University Hospital, Mt. Scopus, Jerusalem, Israel

View larger version (51K): [in a new window]   Figure 1 Scatter plots of highest levels of troponin-I obtained during the first three postoperative days versus the longest ischemia duration recorded on the continuous 12-lead ST-trend monitor. Lines represent the linear regression and the 95% confidence limits. r = Pearson’s correlation coefficient.

View larger version (26K): [in a new window]   Figure 2 Receiver-operator characteristic (ROC) curves of (A). Longest ischemia duration obtained at different cutoff levels of troponin-I representing myocardial infarction. (B) Highest cardiac troponin-I ROC curves obtained at different cutoff values of longest ischemia duration signifying myocardial infarction. AUC = area under the curve.

View larger version (22K): [in a new window]   Figure 3 The time of onset of longest ischemia relative to the end of surgery (T = 0). Striped bars represent the onset time of longest ischemic events of all patients who had ischemia but no myocardial infarction; black bars represent the onset time of longest ischemic events that culminated in myocardial infarction.