Surgery After Recent Myocardial Infarction

Updated September 2, 2013
Author: Annals of Surgery 2011

Description: Risk of repeat MI in surgery after a recent MI


 2011 May;253(5):857-64

Risk of surgery following
recent myocardial infarction

Livhits MKo CYLeonardi MJZingmond DSGibbons MMde Virgilio C .

Source

Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90509, USA.

Abstract

OBJECTIVE:

We aimed to assess the impact of recent myocardial infarction (MI) on outcomes after subsequent surgery in the contemporary clinical setting.

BACKGROUND:

Prior work shows that a history of a recent MI is a risk factor for complications following noncardiac surgery. However, this data does not reflect current advances in clinical management.

METHODS:

Using the California Patient Discharge Database, we retrospectively analyzed patients undergoing hip surgery, cholecystectomy, colectomy, elective abdominal aortic aneurysm repair, and lower extremity amputation from 1999 to 2004 (n = 563,842). Postoperative 30-day MI rate, 30-day mortality, and 1-year mortality were compared for patients with and without a recent MI using univariate analyses and multivariate logistic regression. Relative risks (RR) with 95% confidence intervals were estimated using bootstrapping with 1000 repetitions.

RESULTS:

Postoperative MI rate for the recent MI cohort decreased substantially
as the length of time from MI to operation increased:

Re-infarction Rate:

  • 0-30 days = 32.8%
  • 31-60 days = 18.7%
  • 61-90 days = 8.4%
  • 91-180 days = 5.9%

 

30-day Mortality:

  • 0-30 days = 14.2%
  • 31-60 days = 11.5%
  • 61-90 days = 10.5%
  • 91-180 days = 9.9%

 

MI within 30 days of an operation was associated with a higher risk of postoperative MI (RR range = 9.98-44.29 for the 5 procedures), 30-day mortality (RR range, 1.83-3.84), and 1-year mortality (RR range, 1.56-3.14).

CONCLUSIONS:

A recent MI remains a significant risk factor for postoperative MI and mortality following surgery. Strategies such as delaying elective operations for at least 8 weeks and medical optimization should be considered.

(C) 2011 Lippincott Williams & Wilkins, Inc.