The Danger of Surgery After a Recent Myocardial Infarction
The Danger of Surgery After a Recent Myocardial Infarction
Livhits M, Ko CY, Leonardi MJ, Zingmond DS, Gibbons MM, de Virgilio C
Ann Surg. 2011;253:857-864
How dangerous is surgery after a recent myocardial infarction (MI)? The authors used the California Patient Discharge Database to study patients (n = 563,842) with major surgery (ie, hip, gallbladder, colon, aortic aneurysm repair, lower extremity amputation) between 1999 and 2004. All patients had a recent documented MI prior to surgery. Subsequent infarction rate and overall mortality varied by the time from initial MI. The rate for a second MI was 33% if surgery was performed within a month of the initial MI. The rate dropped steadily to 6% for patients whose surgery was postponed for 3 or more months. Thirty-day overall mortality was 14% if surgery was performed within a month of the initial MI, 10% after 3 months, and approximately 8% after 6 months.
This report, based on a large patient population, updates older studies and demonstrates that prior MI continues to be a significant risk factor for subsequent MI and mortality. The study did not include any data on patients who had cardiac surgery after the initial MI. Surgeons have long been aware of the increased risk for a subsequent MI if surgery is performed within a few months of the initial MI. This report emphasizes that, despite current availability of more effective cardiac drugs, a recent history of MI markedly increases the risk for a postoperative recurrent MI. The risk diminishes over time, so if possible, the prudent approach is to avoid surgery for several months.
Abstract
Risk of Surgery Following Recent Myocardial Infarction
Livhits M, Ko CY, Leonardi MJ, Zingmond DS, Gibbons MM, de Virgilio C
Ann Surg. 2011;253:857-864
Summary
How dangerous is surgery after a recent myocardial infarction (MI)? The authors used the California Patient Discharge Database to study patients (n = 563,842) with major surgery (ie, hip, gallbladder, colon, aortic aneurysm repair, lower extremity amputation) between 1999 and 2004. All patients had a recent documented MI prior to surgery. Subsequent infarction rate and overall mortality varied by the time from initial MI. The rate for a second MI was 33% if surgery was performed within a month of the initial MI. The rate dropped steadily to 6% for patients whose surgery was postponed for 3 or more months. Thirty-day overall mortality was 14% if surgery was performed within a month of the initial MI, 10% after 3 months, and approximately 8% after 6 months.
Viewpoint
This report, based on a large patient population, updates older studies and demonstrates that prior MI continues to be a significant risk factor for subsequent MI and mortality. The study did not include any data on patients who had cardiac surgery after the initial MI. Surgeons have long been aware of the increased risk for a subsequent MI if surgery is performed within a few months of the initial MI. This report emphasizes that, despite current availability of more effective cardiac drugs, a recent history of MI markedly increases the risk for a postoperative recurrent MI. The risk diminishes over time, so if possible, the prudent approach is to avoid surgery for several months.
Abstract
