Abstract 18389: Predictors of Post-operative Myocardial Infarction in Patients with Previous Myocardial Infarction Undergoing Major Non-cardiac Surgery: Analysis of 30-Day Follow up Data from the ACS-NSQIP
Aim: We sought to identify predictors of recurrent Myocardial Infarction (MI), in patients with a recent history of MI, after undergoing a major non-cardiac surgery using a large national contemporary population-based cohort.
Methods: American College of Surgeons National Surgical-Quality Improvement Program (ACS-NSQIP; 2006-2011) database was used to evaluate 30 day outcomes in patients undergoing one of the 16 major surgical procedures who had a history of MI within the last 6 months of the procedure. Patients were stratified based on incidence of repeat MI event within 30 days of the procedure and pre-operative demographic, anthropometric and clinical characteristics were compared among the patient groups. Multivariable adjusted logistic regression analysis was used to identify the significant predictors of postoperative MI among these patients.
Results: A total of 1568 patients with an episode of MI within last 6 months (35.8 % women; Mean age = 70 years) undergoing one of the 16 major surgical procedures (73% vascular surgery; 20% Gastrointestinal surgery) were included in the analysis. Overall, 3.7% (n = 57) patients had repeat MI events within 30 days after surgery. Patients with post-operative MI were older (75 vs.69 years; P value :< 0.001), had higher prevalence of DM (47.4% vs 34.5%; P value; 0.04), and were symptomatic with angina (26.3% vs 15.5%; P value; 0.03) within 30 days prior to procedure. On multivariable adjusted logistic regression analysis, age and presence of angina within 30 days prior to surgery were each independently associated with increased risk of postoperative MI [see Table].
Conclusion: Presence of angina in patients with previous MI who are undergoing major non-cardiac surgery is an independent predictor of recurrent post-operative MI. A more careful approach in pre operative evaluation in patients with angina is warranted to improve surgical outcomes.
Author Disclosures: A. Pandey: None. E. Gupta: None. P. Mody: None. N. Kumar: None. H. Golwala: None. T. Jain: None. A. Sood: None.
- © 2014 by American Heart Association, Inc.