• Eckhard Mauermann, Daniel Bolliger, Jens Fassl, Martin Grapow, Esther E Seeberger, Manfred D Seeberger, Miodrag Filipovic, and Giovanna A L Lurati Buse.
• From the Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy (EM, DB, JF, EES, GALLB); Division of Cardiac Surgery, Basel University Hospital (MG); and Basel University Medical School, Basel, Switzerland (MDS, MF).
• Eur J Anaesthesiol. 2017 May 1; 34 (5): 271-279.

BackgroundThe clinical significance of new pathological Q waves after on-pump cardiac surgery is uncertain.ObjectivesTo determine whether or not either the occurrence per se or the location of new pathological Q waves after on-pump cardiac surgery is associated with 12-month, all-cause mortality and/or major adverse cardiac events (MACEs).DesignObservational cohort study.SettingSingle university hospital from January 2007 to October 2010.PatientsConsecutive adult patients undergoing elective on-pump cardiac surgery with MACE-free survival until at least the 7th postoperative day and available ECGs both preoperatively and on the 7th postoperative day (n = 1464). We conducted a subgroup analysis in patients undergoing isolated coronary artery bypass grafting (n = 740).Main Outcome MeasureOur primary endpoint was 12-month, all-cause mortality and/or MACE, defined as acute coronary syndrome, cardiac arrest, congestive heart failure or re-vascularisation at 12 months. Using logistic regression, we examined the prognostic value of new pathological Q waves according to the Minnesota ECG Code, adjusting for the EuroSCORE II, cardiopulmonary bypass time and peak postoperative troponin T concentrations.ResultsWe included 1464 patients (74% men; mean ± SD age 66 ± 10 years) and observed 103 (7.0%) all-cause deaths and/or MACEs at 12 months. A total of 236 patients (16.1%) had definite or probable new pathological Q waves according to the Minnesota ECG Code. The occurrence of new pathological Q waves per se was not associated with our primary endpoint [adjusted odds ratio, 0.970 (95% confidence interval, 0.540 to 1.648)]. However, the occurrence of a new pathological Q wave in V1 to V5 (anterior) was a strong independent predictor for poor outcome [adjusted odds ratio, 3.461 (95% confidence interval, 1.501 to 7.242)].ConclusionThe current analysis suggests that for patients undergoing elective on-pump cardiac surgery, only new pathological Q waves in V1 to V5 (anterior) in the 7th postoperative day ECG are associated with 12-month, all-cause mortality and/or MACE.Trial RegistrationClinicaltrials.gov identifier: NCT00468598.

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