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Perioperative MI after noncardiac surgery linked to high death rates even if PCI performed
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Patients with perioperative MI following noncardiac surgery have a high mortality rate, even if they undergo PCI, according to findings published in the Journal of the American College of Cardiology.
The researchers found in that population, bleeding events, peak troponin T level and peripheral vascular disease all predict 30-day mortality after PCI, whereas older age, vascular surgery, bleeding events and renal dysfunction predict long-term mortality after PCI.
“The enhanced risk of PCI in the perioperative MI population and the factors that enhance risk should be examined in the context of an ever-expanding universe of perioperative MI and injury,” Harold L. Dauerman, MD, from the cardiology division, University of Vermont Medical Center, wrote in a related editorial. “For the first time, we have a large angiographic database on the correlates of perioperative MI. The high risk of PCI for perioperative MI is not easily explained by anatomic findings or baseline risk factors.”
Harold L. Dauerman
Researchers analyzed data from 1,093 patients at Cleveland Clinic from 2003 to 2012 who had noncardiac surgery and perioperative MI within 7 days. There were 3,832 person-years of follow-up. Among those who underwent PCI, 281 patients had STEMI and 241 had non-STEMI.
The researchers found that, in the overall population, 30-day mortality was 5.2% and 1-year mortality was 15%. In the overall PCI population, 30-day mortality was estimated to be 11.3%.
In the STEMI subgroup of the PCI cohort, 30-day mortality was 31.2%, and among the non-STEMI population it was 8.5%.
Strong predictors of 30-day mortality after PCI included: a bleeding event (OR = 4.33; 95% confidence limits [CL], 1.52-12.3); peak troponin T level (OR = 1.2; 95% CL, 1.08-1.34), and underlying peripheral vascular disease (OR = 4.86; 95% CL, 1.66-14.22).
In that same subgroup, independent predictors of long-term mortality included: older age (HR = 1.03; 95% CL, 1.01-1.04); bleeding (HR = 2.31; 95% CL, 1.61-3.32); renal insufficiency (HR = 2.26; 95% CL, 1.51-3.39) and vascular surgery (HR = 1.48; 95% CL, 1.02-2.15).
Dauerman wrote, “Given the paucity of data on the underlying mechanism of perioperative MI, follow-up studies with histopathology, intracoronary hemodynamics, optimal coherence tomography and cardiac magnetic resonance may be a logical next step in this field.” – by James Clark
Disclosure: One researcher reports receiving institutional research grants from AstraZeneca and consulting for Takeda. The other researchers and Dauerman report no relevant financial disclosures.
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