Peri‐operative silent myocardial ischaemia and long‐term adverse outcomes in non‐cardiac surgical patients*

Two hundred and seventy‐five non‐cardiac surgical patients were recruited to determine risk factors associated with the development of postoperative cardiovascular complications during the first year after surgery. Patients underwent ambulatory electrocardiography pre‐ and postoperatively. There were 34 adverse events over the whole study period. Twenty‐four occurred within 6 months and the remaining 10 occurred between 6 and 12 months postoperatively. Silent myocardial ischaemia was associated with adverse outcome over both the first 6 months [OR 4.44 (95% CI 1.77–11.13)] and the whole study period [OR 2.81 (1.26–6.07)]. Other risk factors were: vascular surgery [OR 17.09 (2.67–351.44)], history of angina [OR 6.29 (2.21–17.62)], concurrent treatment with calcium entry blockers [OR 2.68 (1.03–6.93)] and smoking [OR 4.93 (2.00–12.02)]. None of these was a useful predictor of long‐term outcome (between 6 and 12 months postsurgery). These results are at variance with other published data, but we conclude that monitoring for peri‐operative silent myocardial ischaemia does not aid the prediction of long‐term cardiovascular complications.