Longer delays between heart attacks and elective surgeries lowers death rates and subsequent heart attacks

Study suggests new surgical guidelines could help reduce risks

Before undergoing elective surgery, patients should consider waiting longer after a heart attack than is currently recommended, according to a study scheduled for publication in the May issue of the journal, Annals of Surgery.

The American Heart Association and the American College of Cardiology recommend patients wait at least four to six weeks after a heart attack before undergoing elective surgery. This guidance is based on studies conducted in the 1970s and 1980s.

The new study examined surgical outcomes among more than 550,000 California patients over a five-year period (1999-2004) who underwent five common elective surgeries after a heart attack. Researchers found substantially lower death rates and fewer subsequent heart attacks in those who waited eight or more weeks after a heart attack to undergo hip surgery, gallbladder removal, non-traumatic amputation, colon resection or elective abdominal aortic aneurysm repair.

"Despite medical advancements in the treatment of coronary artery disease today, a recent heart attack remains a very important risk factor for patients undergoing surgery," said Christian de Virgilio, MD, the study's corresponding author and a principal investigator at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed). "Our study suggests that patients should wait at least eight weeks after a heart attack before undergoing elective surgery. The results of the study also reignite the question of whether, in this high risk group, physicians should consider coronary artery stenting or bypass prior to elective surgery."

Researchers found the risk of subsequent heart attacks and death generally declined the longer the time between a heart attack and elective surgery. For instance, the risk of death for heart attack in patients undergoing hip surgery declined nearly 40 percent when the surgery took place more than six months after the heart attack.

Among patients who underwent hip surgery within 30 days of a heart attack, the study found 13.1 percent died within a month. Among those whose hip surgery occurred six months to one year after a heart attack, researchers found the death rate within a month was 7.9 percent. The risk of a subsequent heart attack went from 38.4 percent for hip surgery performed within a month of a heart attack to 6.2 percent for hip surgery performed six months to a year after a heart attack.

"Our research examined a much wider range of patients and surgeries than in past studies, and it points out the importance of a recent heart attack in determining the timing for elective surgeries," said Dr. de Virgilio.