Risk stratification of postoperative asymptomatic ST-segment depression in patients with acute cholecystitis

   Background. Despite the successes in the prevention and treatment of diseases of the circulatory system, mortality from ischemic heart disease (IHD) among the population of the Republic of Belarus occupies a leading position. Late seeking of medical care by patients with coronary artery disease may be due to the peculiarities of the course of the disease, asymptomatic episodes of myocardial ischemia, which do not allow timely suspicion and prevention of an impending coronary catastrophe without conducting instrumental studies and assessing cardiovascular risk. Acute surgical pathology of the abdominal organs can serve as a stress trigger that will worsen the course of asymptomatic coronary atherosclerosis and lead to the manifestation of an ischemic event.

   Aim. To assess the incidence and develop a prognostic model for the occur rence of ST segment depression on the resting electrocardiogram (ECG) in patients after cholecystectomy in the early postoperative period.

   Material and methods. The study included patients with moderate, high and very high risk of cardiovascular complications according to the recommendations of the European Society of Cardiology [1], who had indications for urgent cholecystectomy. Ischemic depression of the ST segment was considered to be an oblique or horizontal depression with a depth of 0.05 mV or more in the standard leads and 0.1 mV or more in the precordial leads, measured at a point 60–80 ms from the point of transition of the S wave to the ST segment.

   Results and discussion. In patients who underwent cholecystectomy but did not use cardioprotective therapy, ST segment depression on the ECG was more common on the 4^th day after surgery. The prevalence of ischemic ST segment depression was higher in both standard and precordial leads. An increase in the incidence of new episodes of myocardial ischemia by day 4 in patients after cholecystectomy without concomitant cardioprotective therapy was also revealed. A model was developed to estimate the likelihood of episodes of ST segment depression after emergency cholecystectomy in the early postoperative period.

   Conclusion. In patients after cholecystectomy in the early postoperative period, episodes of ST segment depression were recorded on the resting ECG. The frequency of asymptomatic episodes of ischemia was higher in the group of patients who underwent cholecystectomy, where no additional cardioprotective therapy was prescribed.

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