Perioperative Acute Myocardial Infarction in Non-Cardiac Operations: A National Analysis

BackgroundPerioperative acute myocardial infarction (POMI) complicates 1-5% of non-cardiac operations, influenced by patient risk factors and surgical complexity. The present study used a contemporary, nationally representative cohort of non-cardiac operation patients to characterize current trends in the incidence and impact of POMI. We hypothesized that POMI remains associated with increased mortality, complications, and resource utilization.MethodsAll adult (>18 years) hospitalizations entailing non-cardiac surgical procedures were identified from the 2016-2022 Nationwide Readmissions Database. Non-cardiac operations included intraabdominal, vascular, orthopedic, thoracic, urinary, gynecology, and otolaryngology procedures. Those experiencing POMI comprised the POMI cohort (others: Non-POMI). Multivariable logistic and linear regression models were developed to evaluate the association of POMI with outcomes of interest including in-hospital mortality, postoperative complications, and non-elective readmissions.ResultsOf an estimated 8 633 451 non-cardiac operations, 66% were elective and 0.92% experienced POMI. Relative to others, POMI were older and had a greater burden of chronic medical conditions. Following comprehensive risk-adjustment, POMI was associated with greater in-hospital mortality. Furthermore, POMI was linked with increased hospitalization duration by 4.25 days and costs by $23 710. Additionally, POMI was associated with increased odds of 30-day non-elective readmissions. A modest increase in POMI incidence was observed over time across operative categories.ConclusionThe incidence of perioperative acute myocardial infarction following non-cardiac operations remains low (∼1%), with modest increases observed across select operative categories. This complication remains associated with substantial mortality, increased resource utilization, and higher rates of non-elective readmissions, underscoring the critical importance of perioperative cardiac risk stratification and optimization.