Delaying Noncardiac Surgery for Several Months After Heart Attack Found to Be Safer
THURSDAY, Nov. 14, 2024 -- Delaying noncardiac surgeries for three to six months following a heart attack appears safer for those who undergo revascularization, according to a study published online Oct. 30 in JAMA Surgery.
Laurent G. Glance, M.D., from the University of Rochester in New York, and colleagues examined the association between the time since a non-ST-segment elevation myocardial infarction (NSTEMI) and the risk for postoperative major adverse cardiovascular and cerebrovascular events (MACCE). The analysis included Medicare claims data (2015 to 2020) for patients 67 years or older who had major noncardiac surgery (roughly 5.2 million surgeries).
The researchers found that compared with patients without a prior NSTEMI, patients with an NSTEMI within 30 days of elective surgery had higher odds of MACCE, regardless of whether they had undergone coronary revascularization (adjusted odds ratio [aOR], 2.15) or not (aOR, 2.04). After 30 days, the odds of postoperative MACCE leveled off in patients who had undergone any coronary revascularization procedure (and after 90 days in patients with drug-eluting stents). However, there was an increase after 180 days (any revascularization at 181 to 365 days: aOR, 1.46; patients with drug-eluting stents at 181 to 365 days: aOR, 1.73). For those not undergoing revascularization, the odds of MACCE did not level off. Findings were similar for all-cause 30-day mortality, except that the odds of mortality in patients with previous NSTEMI who had revascularization leveled off after 60 days in elective surgeries and 90 days for nonelective surgeries.
"Delaying elective noncardiac surgery to occur between 90 and 180 days after an NSTEMI may be reasonable for patients who have had revascularization," the authors write.
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