Juo YY, et al. - Researchers aimed to investigate the temporal trends of myocardial infarction (MI) following high-risk vascular procedures in adults. In the past decade, the incidence of MI did not significantly decreased and had been consistently correlated with worse clinical outcomes. Further inquiry into why advanced perioperative care did not reduce cardiac complications is important to quality patient care.

Methods

• The researchers performed a retrospective cohort study using data collected from January 1, 2005, to December 31, 2013, in the American College of Surgeons National Surgery Quality Improvement Program database, to which participating hospitals across the United States report their preoperative, operative, and 30-day outcome data.
• They identified 90,303 adults who underwent a high-risk vascular procedure-open aortic surgery or infrainguinal bypass-during the study period.
• They divided patients into cohorts based on their year of operation, and their baseline cardiac risk factors and incidence of POMI were compared.
• For inclusion, cases from 2005 to 2014 in the database were eligible if 1 of their Current Procedural Terminology codes matched any of the operations identified as a high-risk vascular procedure.
• From August 1, 2016, to November 15, 2016, data analysis took place.
• The year of the operation was the main exposure.
• Other variables of interest included demographics, comorbidities, and other risk factors for MI.
• The incidence of POMI was the primary outcome of interest.

Results

• A total of 22,836 (25.3%) had undergone open aortic surgery and 67,467 (74.7%) had had infrainguinal bypass, among the 90,303 patients included in the study.
• In this study, 16,391 men (71.9%) were included in the open aortic cohort.
• The open aortic cohort had a mean (SD) age of 69.1 (11.5) years, and was predominantly white (18,440 patients [80.8%] self-identified as white race/ethnicity).
• The infrainguinal bypass cohort comprised 41,845 men (62.1%); mean (SD) age was 66.7 (11.7) years; 51,043 patients (75.7%) were self-identified as white race/ethnicity.
• In this open aortic procedure cohort, patients were more likely to be classified as American Society of Anesthesiologists class IV (7,426 patients [32.6%] vs 15,683 [23.3%] for the infrainguinal bypass cohort) or class V (1,131 [5.0%] vs 206 [0.3%]; P < .001) and to undergo emergency procedures (4,852 [21.3%] vs 4,954 [7.3%]; P < .001) during the study period.
• Furthermore, patients who underwent open aortic procedures experienced significantly higher actual incidence of POMI (464 [3.0%] vs 1,270 [1.9%]; P < .001).
• The incidence of POMI showed no substantial temporal change from 2009 to 2014 (2.7% in 2009 to 3.1% in 2014; P=.64 for trend).
• Postoperative MI was consistently associated with poor prognosis, with a 3.62-fold (95% CI, 2.25-5.82) to 11.77-fold (95% CI, 6.10-22.72) increased odds of cardiac arrest and a 3.01-fold (95% CI, 2.08-4.36) to 6.66-fold (95% CI, 4.66-9.52) increased odds of mortality.