Mortality rate remains high in patients undergoing PCI for an MI following noncardiac surgery

More than 11 percent of patients who developed perioperative MI after vascular surgery and underwent MI died within 30 days of the noncardiac procedure, according to an observational study.

Lead researcher Akhil Parashar, MD, of the Cleveland Clinic, and colleagues published their results online July 18 in the Journal of the American College of Cardiology.

The researchers identified 1,093 patients who underwent coronary angiography for MI at the Cleveland Clinic from 2003 through 2012 and underwent noncardiac surgery within the previous seven days.

Of the patients, 281 underwent PCI, including 40 with a primary diagnosis of STEMI (ST-segment elevation MI) and 241 with a primary diagnosis of NSTEMI (non-ST-segment elevation MI). The median time to PCI after surgery was two days.

The 30-day mortality rate was 5.2 percent in the overall population, 11.3 percent in patients undergoing PCI, 31.2 percent for patients diagnosed with STEMI and 8.5 percent for patients diagnosed with NSTEMI.

A regression analysis found that the following factors were strong predictors of 30-day mortality after PCI: bleeding event after PCI, peak troponin level and underlying peripheral vascular disease.

Meanwhile, a Cox proportional hazard analysis found significant predictors of long-term mortality after PCI included increasing age, bleeding after PCI, renal insufficiency and vascular surgery.

The researchers acknowledged a few limitations of the study, including its observational design and the potential for referral bias and selection bias because many of the patients never made it to the cardiac catheterization laboratory. They also relied on a database that did not identify patients who had perioperative MI who did not undergo angiography. In addition, they said there is no agreement on the definition of perioperative MI.

“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,” the researchers wrote. “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.”