title: Coronary revascularization after myocardial infarction can reduce risks of noncardiac surgery.
abstract: BACKGROUND
  Recent studies suggest that preoperative coronary revascularization overall does not improve outcomes after noncardiac surgery. It is not known whether this holds true for high-risk patients with a history of recent MI. Our objective was to determine whether preoperative revascularization improves outcomes after noncardiac surgery in patients with a recent MI.
  
  
  METHODS
  Using the California Patient Discharge Database, we retrospectively analyzed patients with a recent MI who underwent hip surgery, cholecystectomy, bowel resection, elective abdominal aortic aneurysm repair, and lower extremity amputation from 1999 to 2004 (n = 16,478). Postoperative 30-day reinfarction and 30-day and 1-year mortality were compared for patients who underwent preoperative revascularization (percutaneous transluminal coronary angioplasty, coronary stenting, or coronary artery bypass graft) and those who were not revascularized using univariate analyses and multivariate logistic regression. Relative risks with 95% confidence intervals were estimated using bootstrapping with 1,000 repetitions.
  
  
  RESULTS
  Patients with a recent MI who were revascularized before surgery had an approximately 50% decreased rate of reinfarction (5.1% versus 10.0%; p < 0.001) and 30-day (5.2% versus 11.3%; p < 0.001) and 1-year mortality (18.3% versus 35.8%; p < 0.001) compared with those who were not. Stenting within 1 month of surgery was associated with a trend toward increased reinfarction (relative risk: 1.36; 95% CI, 0.96-1.97), and coronary artery bypass graft was associated with a decreased risk (relative risk: 0.70; 95% CI, 0.55-0.95).
  
  
  CONCLUSIONS
  This large sample representing real world practice suggests that patients with a recent MI can benefit from preoperative revascularization. Coronary artery bypass graft can improve outcomes more than stenting, especially when surgery is necessary within 1 month of revascularization, but additional prospective studies are indicated.
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. mlivhits@mednet.ucla.edu
authors: Masha
authors: M
authors: Livhits
authors: Melinda Maggard
authors: MM
authors: Gibbons
authors: Christian
authors: C
authors: de Virgilio
authors: Jessica B
authors: JB
authors: O'Connell
authors: Michael J
authors: MJ
authors: Leonardi
authors: Clifford Y
authors: CY
authors: Ko
authors: David S
authors: DS
authors: Zingmond
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D002140:California / Q000453:epidemiology; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D015607:Stents; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome