Impact of the American College of Cardiology/American Heart Association guidelines for interpretability of continuous electrocardiography on the association of silent ischemia with troponin release after major noncardiac surgery.

INTRODUCTION: Preexisting electrocardiographic abnormalities may limit accuracy of continuous electrocardiography (cECG) for ischemia determination. The American College of Cardiology/American Heart Association published criteria for the exclusion of unsuitable cECG curves from ST-segment interpretation. These criteria consider medication and 12-lead ECG findings (medication- and 12-lead ECG-based criteria) and cECG lead characteristics (cECG-based criteria). METHODS: We recorded cECG in 300 patients undergoing major noncardiac surgery. We determined postoperative troponin and 12-month outcome. We compared the associations of cECG-detected ischemia with troponin and 12-month outcome with and without adherence to the criteria. RESULTS: Adherence to the medication- and 12-lead ECG-based criteria enhanced the association between troponin and perioperative ischemia in CM5 (odds ratio, 3.74; 95% confidence interval, 1.88-7.44) and 7.03 (2.67-18.49), respectively; P = .049). Similarly, the association between ischemia in CM5 and 12-month outcome tended to increase (P = .081). CONCLUSIONS: Applying the guideline criteria for the interpretation of cECG enhanced cECG diagnostic value in surgical patients.