AoS: Prolonging surgery post-MI can reduce death

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Waiting longer after an MI to undergo elective surgery could actually be beneficial, according to a study published in the May issue of the Annals of Surgery.

While currently the American Heart Association and American College of Cardiology recommend that MI patients wait at least four to six weeks to undergo such elective surgery, these new data suggest that this guidance, which dates back to studies performed in the '70s and '80s, is not adequate for today.

Christian de Virgilio, MD, principal investigator of the study from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed) and colleagues evaluated surgical outcomes of more than 550,000 Californians between 1999 and 2004 who underwent five elective surgeries—hip surgery, gallbladder removal, non-traumatic amputation, colon resection or elective abdominal aortic aneurysm repair—post-MI.

The researchers reported that patients who waited eight or more weeks after an MI to undergo the aforementioned surgeries saw reduced rates of death and fewer subsequent MIs compared with those who followed AHA and ACC guidelines.

“The results of the study also re-ignite the question of whether, in this high risk group, physicians should consider coronary artery stenting or bypass prior to elective surgery,” wrote de Virgilio.

The risk of death for MI patients undergoing elective hip surgery declined almost 40 percent when the patient underwent surgery more than six weeks after an MI. In contrast, patients who underwent hip surgery within 30 days of an MI, 13.1 percent died within one month.

When hip surgeries took place six months to one year after MI, death rates within a month were 7.9 percent. Lastly, the risk of experiencing a subsequent MI when hip surgery was performed within a month of an MI was 38.4 percent compared with a 6.2 percent risk when the surgery was performed six months to a year post-MI.

"Our research examined a much wider range of patients and surgeries than in past studies, and it points out the importance of a recent heart attack in determining the timing for elective surgeries," said de Virgilio.