Perioperative Acute Myocardial Infarction Increases Mortality Following Noncardiac Surgery

ObjectiveTo provide insight into diagnosis, treatment, and prevention of perioperative myocardial infarction (PMI).DesignThe authors retrospectively analyzed PMI characteristics in patients undergoing noncardiac surgery and identified risk factors for death.SettingAn affiliated teaching hospital with about 1500 beds.ParticipantsThe authors screened electronic medical records and retrospectively analyzed clinical data from 117,856 patients who underwent noncardiac surgery during the period from August 2003 through June 2011.InterventionsPatients were divided into two groups based on survival at 30 days after PMI.Measurements and Main ResultsPMI was reported in 61 patients, for an overall incidence rate of 5.2 per 10,000. PMI incidence increased significantly with age, with a rate of 0.97 per 10,000 for the 45- to 60-year-old group, and increasing to a rate of 40.4 per 10,000 for the>75-year-old group (p<0.001). The mortality rate of non-PMI patients (n = 117,795) was 0.32%, whereas the mortality rate for the 61 PMI patients was 36.1% (p<0.001). PMI occurred acutely (within 48 to 72 hours of surgery) in the majority of patients (78.7%), and only 18% of these patients complained of chest pain. The majority of patients who suffered PMI had non-ST segment elevation acute myocardial infarction (78.7%). By multiple logistic regression analysis, lack of anticoagulation/antiplatelet therapy and cardiogenic shock were independent risk factors for death in PMI patients (p = 0.001 for both).ConclusionsPMI incidence increased significantly with advanced age. PMI increased mortality following non-cardiac surgery. The independent risk factors for death in PMI patients following noncardiac surgery were lack of anticoagulation/antiplatelet therapy and cardiogenic shock.