Patients who experienced perioperative myocardial infarction (MI) after a noncardiac surgery had a higher risk of mortality, despite undergoing percutaneous coronary intervention (PCI), according to recent data published in the Journal of the American College of Cardiology.
Akhil Parashar, MD, from the Department of Internal Medicine at the Cleveland Clinic in Ohio, and colleagues evaluated the angiographic characteristics and outcomes of 1093 patients with MI sustained within 7 days of undergoing noncardiac surgery. Within the patient population, 281 patients underwent PCI—40 with ST-segment elevation MI (STEMI) and 241 with non-ST-segment elevation MI (NSTEMI).
“Perioperative MI has a markedly high mortality rate after PCI, with more than 1 in 4 patients and 1 in 10 patients not surviving beyond 30 days after STEMI and NSTEMI, respectively,” the authors wrote.
The overall 30-day mortality rate was 5.2% and 1-year mortality was 15% and within the PCI subgroup, the estimated 30-day mortality was 11.3%. Researchers also noted that within the PCI subgroup, the 30-day mortality rate was 31.2% in the STEMI cohort and 8.5% in the NSTEMI cohort.
Factors that were strong predictors of 30-day mortality after PCI included a bleeding event after PCI (odds ratio [OR]: 4.33; 95% confidence limit [CL]: 1.52-12.30), peak troponin T level (OR: 1.20; 95% CL: 1.08-1.34), and underlying peripheral vascular disease (OR: 4.86; 95% CL: 1.66-14.22).
In addition, predictors of long-term mortality after PCI included increasing age (hazard ratio [HR]: 1.03; 95% CL: 1.01-1.04), bleeding after PCI (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).
The investigators noted that the results provided valuable information regarding all-cause mortality within subgroups of MI following noncardiac surgery. “These data from our study provide clinicians with a better understanding of coronary anatomy and outcomes in this high-risk patient population, which may help to bridge the knowledge gap on the role of PCI for these patients,” they concluded.
“It also advocates for more prospective studies and randomized controlled trials, especially in patients who are to undergo any form of vascular surgery and more so if they have underlying comorbidities including renal insufficiency or high risk of bleeding.”
Parashar A, Agarwal S, Krishnaswamy A, et al. Percutaneous intervention for myocardial infarction after noncardiac surgery: patient characteristics and outcomes. J Am Coll Cardiol. 2016;68(4):329-338. doi: 10.1016/j.jacc.2016.03.602.