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Recent MI possible significant risk factor for postoperative MI, death

Livhits M. Ann Surg. 2011;doi:10.1097/SLA.0b013e3182125196.

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Patients who experienced an MI within 30 days of an operation had higher rates of MI 30 days after the procedure, as well as mortality at 1 year, according to a new study in the Annals of Surgery.

Christian de Virgilio, MD, principal investigator at Los Angeles Biomedical Research Institute and the study’s corresponding researcher, told CARDIOLOGY TODAY that this study “provides contemporary data regarding the risk of postoperative MI in patients who have had a recent prior MI, across a broad spectrum of surgical procedures.”

In the study, de Virgilio and colleagues utilized the California Patient Discharge Database to retrospectively analyze patients (n=563,842) who underwent cholecystectomy, colectomy, hip surgery, elective abdominal aortic aneurysm repair and lower extremity amputation from 1999 to 2004. They compared rates of postoperative 30-day MI, 30-day mortality and 1-year mortality between patients with and without a recent MI.

Results showed that postoperative MI rate among patients with a recent MI decreased substantially over time (0-30 days, 32.8%; 31-60 days, 18.7%; 61-90 days, 8.4%; 91-180 days, 5.9%), with rates of 30-day mortality sharing a similar trend (0-30 days, 14.2%; 31-60 days, 11.5%; 61-90 days, 10.5%; 91-180 days, 9.9%). Additionally, MI within 30 days of an operation correlated with a higher risk for postoperative MI (RR range, 9.98-44.29), 30-day mortality (RR range, 1.83-3.84) and 1-year mortality (RR range, 1.56–3.14).

For de Virgilio, these findings should increase awareness of the importance of a recent MI as a major predictor of having another MI and of perioperative death.

“In light of these data, patients with a recent MI who are being considered for elective surgery should carefully weigh the risks and benefits of the procedure and, if at all possible, delay surgery for at least 2 months — if not longer,” he said. “They should [also] be evaluated by a cardiologist to determine whether further intervention is needed prior to surgery.” – by Brian Ellis

Disclosure: Dr. de Virgilio reports no relevant financial disclosures.

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