Can vascular surgery be performed soon after myocardial infarction?

Abstract

We undertook the present study to test the hypothesis that in a contemporary setting of high rates of use of effective medical therapy and coronary revascularization, vascular surgery soon after myocardial infarction (MI) may not be prohibitively risky within 1 year. Elective vascular surgery is generally contraindicated within the first six months of MI. However, this principle is based on high complication rates from old case series. Forty six consecutive patients underwent 63 vascular procedures after MI. Thirty major arterial reconstructions, 9 thromboembolectomies, and 22 amputations or revisions were performed. We compared patients who had vascular surgery within six months after MI (Group I, n = 30) to patients who had surgery six to 12 months after MI, Group II (n = 16). Both groups had similar demographic characteristics, coronary risk factors and Goodman and Cooperman scores of operative risk. The high overall prevalence of coronary revascularizations (37%) and treatment with aspirin (87%), beta-blockers (65%) and ACE-inhibitors (76%), did not differ significantly between both groups. There was no significant difference in the incidence of reinfarction, cardiac mortality, or total mortality in the two groups. Patients undergoing vascular surgical procedures soon after acute MI may not have prohibitively high rates of death and cardiovascular complications. These favorable outcomes may be associated with the use of effective medical therapy and coronary revascularization. Vascular surgery should not be postponed in patients with recent MI.