The Optimal Timing for Patients With Acute Myocardial Infarction to Safely Undergo Elective Non-Cardiac Surgery: A Retrospective Cohort Study.

Abstract

Objective: To evaluate the optimal timing of non-cardiac surgery for patients to achieve acceptable postoperative outcomes after acute myocardial infarction (AMI).

Methods: We used a health insurance database to identify patients aged > 40 years who underwent non-cardiac surgery between 2010 and 2021 in Taiwan. Through frequency matching by age and sex at a 1:10 ratio, patients with and without AMI within 12 months before non-cardiac surgery were selected as study subjects. We compared postoperative complications and mortality between patients with and without a prior AMI by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression models.

Results: Compared with 103880 people without AMI, the 10388 patients with a prior AMI had increased risks of 30-day mortality (OR 6.93, 95% CI 5.78-8.29), pulmonary embolism, acute renal failure, pneumonia, septicemia, and stroke after non-cardiac surgery. Patients who underwent non-cardiac surgery within 1 month after AMI had a higher risk of postoperative 30-day mortality (OR 10.8, 95% CI 9.03-12.8), which decreased in those who underwent surgery within 13-24 months (OR 2.44, 95% CI 1.82-3.26).

Conclusion: Patients with a history of AMI within 12 months had a higher risk of complications and mortality after non-cardiac surgery. The risk of postoperative 30-day mortality was highest within 1 month after prior AMI and significantly decreased at the 1-year mark, nearing a return to baseline at 3 years. The timing of elective surgery should be individualized and determined by the surgical care team according to the patient's medical condition.