• Sameh M Hakim, Dalia M Elfawy, Heba B Elserwi, and Mohammad K Saad.
• Department of Anesthesiology and Intensive Care, Ain Shams University Faculty of Medicine, Cairo, Egypt - hakimsm@med.asu.edu.eg.
• Minerva Anestesiol. 2020 Jun 1; 86 (6): 652-661.

IntroductionThe aim of this review is to examine current evidence on value of new ST-segment or T-wave changes for prediction of major adverse cardiac events (MACE) after vascular surgery.Evidence AcquisitionWe searched PudMed, EMBASE and Cochrane Library databases for studies examining the relation between new ST-segment elevation or depression or T-wave inversion and MACE following vascular surgery. MACE was defined as fatal or non-fatal myocardial infarction, cardiac death, unstable angina, cardiac arrest, congestive heart failure, ischemic pulmonary edema, major ventricular arrhythmia or complete heart block.Evidence SynthesisEight eligible studies involving 1083 patients were included in meta-analysis. There was heterogeneity across included studies with possibility of publication bias. New ST-segment/T-wave changes had an imputed risk ratio (RR) for MACE of 2.04 (95% CI: 0.87 to 4.78). The overall predictive value was good (area under receiver-operating characteristic curve, 0.85; 95% CI: 0.83 to 0.90) with a sensitivity of 0.61 (95% CI: 0.55 to 0.67), specificity of 0.75 (95% CI: 0.72 to 0.78), and diagnostic odds ratio (DOR) of 13.03 (95% CI: 8.25 to 20.57). Meta-regression identified age (P value <0.01) and duration of ECG surveillance (P value <0.01) as possible sources for observed heterogeneity in RR. Neither factor influenced the DOR (P value, 0.87 and 0.36, respectively).ConclusionsCurrent evidence suggests that in the setting of vascular surgery, new ST-segment/T-wave changes could serve as predictor of MACE with reasonable accuracy. Heterogeneity across studies, possibility of publication bias and paucity of eligible studies are potential limitations to these conclusions.

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