Background: Knowledge of the prognostic information of preoperative 12- lead electrocardiogram(ECG) recordings in patients with coronary artery disease(CAD) undergoing noncardiac surgery is limited. Methods: The prognostic information derived from the preoperative ECGs of 172 CAD patients undergoing major noncardiac surgery was analyzed to determine its predictive value for long- term outcome. Primary end point was all- cause mortality; secondary end point was major adverse cardiac events(MACE) at 2 years. Results: Prevalence of ECG abnormalities was 53% for T- wave alterations; 46% for Q waves; 38% for ST deviations; and, depending on the criterion used, 2% to 19% for left ventricular hypertrophy. During follow- up, 40(23% ) patients died and 31(18% ) had MACE. After adjustment for clinical baseline findings, including current medication with β - blockers, ST depressions(odds ratio [OR] 4.5, 95% confidence interval [CI] 1.9- 10.5) and faster heart rate(HR)(OR 1.6, 95% CI 1.1- 2.4, per 10 beats per minute [bpm] increase) were independent predictors of all- cause mortality. Faster HR(OR 1.7, 95% CI 1.1- 2.6, per 10- bpm increase) was also an independent predictor of MACE. The predictive value of ECG variables did not change after adjustment for occurence of perioperative ischemia. Conclusion: In CAD patients, the preoperative ECG contains important prognostic information and is predictive of long- term outcome independent of clinical findings and perioperative ischemia.
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