ImportanceDelaying elective noncardiac surgery after a recent acute myocardial infarction is associated with better outcomes, but current American Heart Association recommendations are based on data that are more than 20 years old.ObjectiveTo examine the association between the time since a non–ST-segment elevation myocardial infarction (NSTEMI) and the risk of postoperative major adverse cardiovascular and cerebrovascular events (MACCE).Design, Setting, and ParticipantsThis cross-sectional study examined Medicare claims data between 2015 and 2020 for patients 67 years or older who had major noncardiac surgery. Data were analyzed from September 21, 2023, to February 1, 2024.ExposureTime elapsed between a prior NSTEMI and surgery.Main Outcomes and MeasuresMACCE (30-day mortality, in-hospital myocardial infarction, heart failure, or stroke) and all-cause 30-day mortality. Multivariable logistic regression was used to estimate the association between outcomes and time since a prior NSTEMI.ResultsThe sample included 5 227 473 surgeries. The mean (SD) age was 75.7 (6.6) years; 2 981 239 (57.0%) were female, and 2 246 234 (43%) were male. There were 42 278 patients (0.81%) with a previous NSTEMI. Compared with patients without a prior NSTEMI, patients with an NSTEMI within 30 days of elective surgery had higher odds of MACCE, regardless of whether they had undergone coronary revascularization (adjusted odds ratio [aOR], 2.15; 95% CI, 1.09-4.23; P = .03) or not (aOR, 2.04; 95% CI, 1.31-3.16; P = .001). The odds of postoperative MACCE leveled off after 30 days in patients who had undergone any coronary revascularization procedure (and after 90 days in patients with drug-eluting stents) and then increased after 180 days (any revascularization at 181-365 days: aOR, 1.46; 95% CI, 1.25-1.71; P < .001; patients with drug-eluting stents at 181-365 days: aOR, 1.73; 95% CI, 1.42-2.12; P < .001). The odds of MACCE did not level off for patients who did not have revascularization. Findings for all-cause 30-day mortality were similar to those for MACCE, except that the odds of mortality in patients with previous NSTEMI who had revascularization leveled off after 60 days in elective surgeries and 90 days for nonelective surgeries (elective 30-day: aOR, 2.88; 95% CI, 1.30-6.36; P = .009; elective 61- to 90-day: aOR, 1.03; 95% CI, 0.57-1.86; P = .92; nonelective 30-day: aOR, 1.91; 95% CI, 1.52-2.40; P < .001; nonelective 91- to 120-day: aOR, 1.00; 95% CI, 0.73-1.37; P = .99).Conclusions and RelevanceThis study found that among older patients undergoing noncardiac surgery who had revascularization, the odds of postoperative MACCE and mortality leveled off between 30 and 90 days and then increased after 180 days. The odds did not level off for patients who did not have revascularization. Delaying elective noncardiac surgery to occur between 90 and 180 days after an NSTEMI may be reasonable for patients who have had revascularization.

中文翻译：

---

自既往 NSTEMI 和非心脏手术后主要不良心脑血管事件以来的时间


重要性在近期急性心肌梗死后推迟择期非心脏手术与更好的结果相关，但目前美国心脏协会的建议基于 20 多年的数据。目的探讨非 ST 段抬高型心肌梗死 （NSTEMI） 后时间与术后主要不良心脑血管事件 （MACCE） 风险的相关性。设计、设置和参与者这项横断面研究检查了 2015 年至 2020 年间 67 岁或以上接受过重大非心脏手术的患者的医疗保险索赔数据。数据分析时间为 2023 年 9 月 21 日至 2024 年 2 月 1 日。主要结局和指标MACCE （30 天死亡率、院内心肌梗死、心力衰竭或中风） 和全因 30 天死亡率。多变量 logistic 回归用于估计自既往 NSTEMI 以来结局与时间之间的关联。结果样本包括 5 227 473 例手术。平均 （SD） 年龄为 75.7 （6.6） 岁;女性 2 981 239 例 （57.0%），男性 2 246 234 例 （43%）。有 42 278 例患者 （0.81%） 既往有 NSTEMI。与既往无 NSTEMI 的患者相比，择期手术后 30 天内发生 NSTEMI 的患者发生 MACCE 的几率更高，无论他们是否接受过冠状动脉血运重建 （校正比值比 [aOR]，2.15;95% CI，1.09-4.23;P = .03） 或不 （aOR， 2.04;95% CI， 1.31-3.16;P = .001）。在接受任何冠状动脉血运重建手术的患者中，术后 MACCE 的几率在 30 天后趋于平稳（对于使用药物洗脱支架的患者，在 90 天后），然后在 180 天后增加（在 181-365 天时进行任何血运重建：aOR，1.46;95% CI，1.25-1.71;P < .001;181-365 天时药物洗脱支架的患者： aOR，1.73;95% CI，1.42-2.12;P < .001）。对于未进行血运重建的患者，MACCE 的几率并未趋于平稳。全因 30 天死亡率的结果与 MACCE 的结果相似，不同之处在于既往 NSTEMI 患者在择期手术 60 天和非择期手术 90 天后血运重建的死亡率趋于平稳（择期 30 天：aOR，2.88;95% CI，1.30-6.36;P = .009;选择性 61 至 90 天：aOR，1.03;95% CI，0.57-1.86;P = .92;非选择性 30 天：aOR，1.91;95% CI，1.52-2.40;P < .001;非选择性 91 至 120 天：aOR，1.00;95% CI，0.73-1.37;P = .99）。结论和相关性本研究发现，在接受血运重建的非心脏手术的老年患者中，术后 MACCE 和死亡率的几率在 30 至 90 天之间趋于平稳，然后在 180 天后增加。对于未进行血运重建的患者，患病率并未趋于平稳。对于已进行血运重建的患者，在 NSTEMI 后 90 至 180 天内延迟择期非心脏手术可能是合理的。