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Characteristics and Outcomes of Type 1 versus Type 2 Perioperative Myocardial Infarction After Noncardiac Surgery

  • Nathaniel R. Smilowitz
    Correspondence
    Requests for reprints should be addressed to Nathaniel Smilowitz, MD, Assistant Professor of Medicine, The Leon H. Charney Division of Cardiology, NYU Langone Health, NYU School of Medicine, 423 East 23rd Street, Room 12020-W, New York, NY 10010
    Affiliations
    Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York

    Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY
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  • Binita Shah
    Affiliations
    Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York

    Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY
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  • Kurt Ruetzler
    Affiliations
    Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
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  • Santiago Garcia
    Affiliations
    Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
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  • Jeffrey S. Berger
    Affiliations
    Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York

    Department of Surgery, New York University School of Medicine, New York
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Published:September 21, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.08.028

      Abstract

      Background

      Perioperative myocardial infarction is frequently attributed to type 2 myocardial infarction, a mismatch in myocardial oxygen supply-demand without unstable coronary artery disease. Our aim was to identify characteristics, management, and outcomes of perioperative type 1 versus type 2 myocardial infarction among surgical inpatients.

      Methods

      Adults age ≥45 years hospitalized for noncardiac surgery were identified in the United States. Perioperative myocardial infarction were identified using International Classification of Diseases, 10th revision (ICD-10) codes. Clinical characteristics, invasive myocardial infarction management, mortality, and readmissions were assessed by myocardial infarction subtype.

      Results

      Among 4,755,382 surgical hospitalizations, we identified 38,975 perioperative myocardial infarctions (0.82%), with type 2 infarction in 42%. Patients with type 2 myocardial infarction were older, more likely to be women, and less likely to have cardiovascular comorbidities compared with type 1 myocardial infarction. Fewer patients with type 2 myocardial infarction underwent invasive management than type 1 myocardial infarction (6.7% vs 28.8%, P < .001). Type 2 myocardial infarction mortality was lower than type 1 myocardial infarction mortality (12.1% vs 17.4%, P < .001; adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.45-0.59). Invasive management of perioperative myocardial infarction was associated with lower mortality in type 1 (aOR 0.56, 95% CI 0.49-0.74) but not type 2 (aOR 1.19, 95% CI 0.77-1.85) myocardial infarction. Among survivors, there was no difference in 90-day hospital readmission between type 2 and type 1 perioperative myocardial infarction (36.5% vs 36.1%, P = .72).

      Conclusions

      Type 2 myocardial infarctions account for approximately 40% of perioperative myocardial infarctions. Patients with type 2 perioperative myocardial infarction are less likely to undergo invasive management and have lower mortality compared with those with type 1 perioperative myocardial infarction.

      Graphical Abstract

      Keywords

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