Outcomes of Patients Undergoing Emergent Cardiac Catheterization for Perioperative Myocardial Infarction

Background
Cardiac complications constitute the most common cause of postoperative morbidity and mortality. Few studies have explored percutaneous coronary intervention (PCI) in non-cardiothoracic perioperative myocardial infarction (PMI). In older studies, patients who experienced PMI and underwent PCI were shown to have mortality rates as high as 11% at 30 days and 26% at one year. We hypothesize that in a small single center study; in which patients are risk stratified for PCI more carefully, mortality rates in these patients are significantly lower than previously reported. We aim to show that revascularization may have a more significant role in these patients than previously described.

Methods
In this observational, retrospective study, we reviewed data from 2009-2016 on 114 patients who had coronary angiography within 14 days of a non-cardiothoracic surgery. We compared patients who had PCI to patients who did not have PCI using two-sample t-test, Wilcoxon rank sum test, and Fisher’s exact test. We evaluated in-patient, 30 day and 1 year mortality. For the PCI subgroup of patients, we analyzed patients who had ST-elevation myocardial infarction (STEMI) vs. non-ST-elevation myocardial infarction (NSTEMI).

Results
Among these 114 patients, the mean age was 68.4±12.8 years with a BMI of 29.2±6.5 kg/m2, and 57.6% were male. There were 11.9% (14) who underwent PCI. Overall mortality rate was 5.2% (6) during hospitalization, 6.1% (7) at 30 days, and 9.6% (11) at 1 year. In the PCI subgroup, 21.4% (3) patients had STEMI and 64.2% (9) patients had NSTEMI. Mortality among PCI patients was 0% in-patient, 7.14% (1) at 30 days and 7.14% (1) at one year.

Conclusions
Our study suggests that the mortality rates for PMI patients undergoing PCI may be dramatically lower than older published studies have described. Mortality rates among patients undergoing cardiac catheterization remain unchanged. However, we believe that with a more conscientious selection process of patients who are good candidates to receive PCI, there would be considerably lowered mortality rates and that revascularization could play an expanded role in these cases.