Identifying Predictors of Postoperative Myocardial Infarction Following Repair of Abdominal Aortic Aneurysm Using a...

To evaluate the incidence of postoperative myocardial infarction (POMI) at 30 and 90 days following abdominal aortic aneurysm (AAA) repair and to examine its association with surgical approach (open v endovascular), preexisting comorbidities, and preoperative medications using a large national cohort.

A non-randomized, retrospective cohort study.

Analysis of the PearlDiver Mariner Database, a nationally representative all-payer claims database in the United States.

A total of 37,386 patients who underwent AAA repair between 2010 and 2023 were included.

Patients underwent either open surgical AAA repair or endovascular aneurysm repair (EVAR).

The incidence of POMI was 2.7% at 30 days and 3.7% at 90 days postoperatively. Despite EVAR patients having a greater burden of baseline comorbidities, open repair was associated with significantly higher odds of POMI at both time points. After multivariable logistic regression adjusted for baseline characteristics, these associations persisted. Several comorbidities were independently associated with increased risk of POMI, with prior myocardial infarction showing the strongest association at both 30 and 90 days.

Open AAA repair is linked to significantly greater odds of POMI compared to EVAR after multivariate analysis. A history of myocardial infarction was the most predictive risk factor for postoperative cardiac events. These findings raise the possibility that extending postoperative surveillance beyond 30 days may identify additional clinically relevant events, warranting further investigation in prospective studies.