Gender independence of ambulatory electrocardiographic monitoring in predicting perioperative cardiac risk

Perioperative ambulatory electrocardiographic (ECG) monitoring for myocardial ischemia has been shown to be useful in predicting postoperative morbid cardiac events, and postoperative myocardial ischemia was found to be the strongest predictor of perioperative cardiac morbidity in 454 high-risk patients undergoing noncardiac surgery.^1-3 The populations studied were either comprised largely of men, or women were not evaluated separately. Because of concern that prediction of cardiac risk in women may not be definable by studies performed in predominantly male populations, and because the sensitivity and specificity of exercise ECG changes (including ST-segment depression) for detecting coronary artery disease are lower in women than in men,⁴ we examined the usefulness of preoperative silent ischemia identified by ambulatory monitoring by gender.