A recent heart attack remains a significant risk factor for complications and death after major surgery, despite advances in clinical management, researchers reported.

But the risk of a postoperative MI or death decreased substantially as the time between the first MI and the surgery increased, according to Christian de Virgilio, MD, of the Los Angeles Biomedical Research Institute in Torrance, Calif., and colleagues.

Current guidelines suggest a four- to six-week delay between a heart attack and surgery, but these new findings suggest that the delay should be at least eight weeks if possible
Research in the 1970s and ’80s showed that a recent heart attack was risky in surgical patients, but new management techniques — including such things as beta-blockers and statins — have changed the clinical landscape, the researchers noted.
The researchers found:

• Patients without a previous MI had a postoperative 30-day heart attack rate of 1.4%.
• Among patients with a heart attack in the previous year, 32.8% of those undergoing emergency surgery and 27.2% of those having an elective procedure had a new MI within 30 days.
• The 30-day mortality rate among those without a previous MI was 3.9% and the one-year mortality was 13.3%.
• Among patients with a heart attack in the previous year, the comparable figures for emergency surgery were 14.2% and 41.2%, respectively, and for elective surgery were 12.9% and 39.1%.

The risk of any of the three outcomes fell markedly as the time between the previous MI and the surgery rose. The researchers cautioned that the administrative database they used lacked some important clinical information, such as the type of recent MI. The findings may not apply outside California, they added, or to other types of procedures.

Action Points

• A  recent heart attack remains a significant risk factor for complications and death after major surgery.
• The risk of a postoperative MI or death decreased substantially as the time between the first MI and the surgery increased.
• Note that these new findings suggest that the delay should be at least 60 days if possible.

Ref:   http://www.medpagetoday.com/Cardiology/MyocardialInfarction/25570