Juo YY, et al. - The aim with which this study was performed was to assess the temporal trends of myocardial infarction (MI) following high-risk vascular procedures. Despite major advances in perioperative cardiac care in the past decade and the availability of an endovascular surgical approach, there appeared no significant decrease in the incidence of postoperative MI following high-risk vascular procedures.

Methods

• 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 recognized a total of 90,303 adults who underwent a high-risk vascular procedure-open aortic surgery or infrainguinal bypass-during the study period.
• On the basis of the year of operation, the patients were divided into cohorts.
• They compared the baseline cardiac risk factors and postoperative myocardial infarction (POMI) incidence among the cohorts.
• For inclusion, cases from 2005 to 2014 in the database were eligible if one of their Current Procedural Terminologycodes matched any of the operations identified as a high-risk vascular procedure.
• From August 1, 2016, to November 15, 2016, they performed data analysis.

Results

• This study included 90,303 patients; 22,836 (25.3%) had undergone open aortic surgery and 67,467 (74.7%) had had infrainguinal bypass.
• The open aortic cohort was consisted of 16,391 men (71.9%), had mean (SD) age of 69.1 (11.5) years and had predominance of white patients (18,440 patients [80.8%] self-identified as white race/ethnicity).
• The infrainguinal bypass cohort was comprised of 41,845 men (62.1%), had a mean (SD) age of 66.7 (11.7) years, and had 51,043 patients (75.7%) who self-identified as white race/ethnicity.
• Patients who underwent open aortic procedures were more frequently classified as American Society of Anesthesiologists class IV (7426 patients [32.6%] vs 15 683 [23.3%] for the infrainguinal bypass cohort) or class V (1131 [5.0%] vs 206 [0.3%]; P < .001) and underwent emergency procedures (4852 [21.3%] vs 4954 [7.3%]; P < .001) during the study period.
• Significantly higher actual incidence of POMI was observed in the open aortic procedure cohort (464 [3.0%] vs 1270 [1.9%]; P < .001).
• From 2009 to 2014, no substantial temporal change was evident in the incidence of POMI (2.7% in 2009 to 3.1% in 2014; P=.64 for trend).
• In this study, postoperative MI was consistently correlated 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.