Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;135(2):202-210.e3.
doi: 10.1016/j.amjmed.2021.08.028. Epub 2021 Sep 22.

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

Nathaniel R Smilowitz  1 , Binita Shah  2 , Kurt Ruetzler  3 , Santiago Garcia  4 , Jeffrey S Berger  5
Affiliations

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

Nathaniel R Smilowitz et al. Am J Med. 2022 Feb.

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.

Keywords: Coronary angiography; Coronary revascularization; Invasive management; Mortality; Myocardial infarction; Outcomes; Percutaneous coronary intervention; Perioperative; Readmission; Rehospitalization; Type 1; Type 2.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Incidence of type 1 and type 2 perioperative myocardial infarction by surgical subtype
Figure 2.
Figure 2.
Post-operative in-hospital mortality in patients with type 1, type 2, and no perioperative myocardial infarction, stratified by surgical subtype.
Figure 3.
Figure 3.
Post-operative in-hospital mortality in patients with type 1 and type 2 myocardial infarction, stratified by invasive versus conservative management.
See this image and copyright information in PMC

References

    1. Smilowitz NR, Gupta N, Guo Y, Berger JS, Bangalore S. Perioperative acute myocardial infarction associated with non-cardiac surgery. Eur Heart J. 2017;38:2409–2417 - PubMed
    1. Smilowitz NR, Gupta N, Ramakrishna H, Guo Y, Berger JS, Bangalore S. Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery. JAMA Cardiol. 2017;2:181–187 - PMC - PubMed
    1. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Executive Group on behalf of the Joint European Society of Cardiology/American College of Cardiology/American Heart Association/World Heart Federation Task Force for the Universal Definition of Myocardial I. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138:e618–e651 - PubMed
    1. Barrett M, Steiner C, Andrews R, Kassed C, Nagamine M. Methodological issues when studying readmissions and revisits using hospital adminstrative data. HCUP Methods Series Report # 2011–01. 2011
    1. Hanson I, Kahn J, Dixon S, Goldstein J. Angiographic and clinical characteristics of type 1 versus type 2 perioperative myocardial infarction. Catheter Cardiovasc Interv. 2013;82:622–628 - PubMed

Publication types