Myocardial Infarction Within One Year of Total Hip Arthroplasty Increases Medical Complications in a Time-Dependent Manner.

Abstract

The purpose of this study was to evaluate how the timing, type, and treatment of a myocardial infarction (MI) before total hip arthroplasty (THA) affect postoperative cardiac and general medical complications. A retrospective comparative study was conducted using a national administrative claims database. Patients undergoing primary THA with at least two years of active data were included. Patients who had an MI within two years before THA were identified and matched 1:4 with controls based on demographic variables and comorbidities. The MI patients were stratified by timing of their MI before THA: MI zero to six months, six to 12 months, 12 to 18 months, and 18 to 24 months before THA. Rates of postoperative cardiac and general medical complications were compared among groups. Subanalyses on MI type, treatment, and location were performed. A history of MI was associated with an increased risk of postoperative MI (odds ratio [OR]: 4.06; 95% confidence interval [CI]: 3.03 to 5.43), heart failure (OR: 1.65, 95% CI: 1.32 to 2.07), and 90-day mortality (OR: 2.22, 95% CI: 1.25 to 3.96). Risk of MI was highest for those who had an MI within 6 months of THA, particularly for type 1 MI (OR: 8.07, 95% CI: 5.74 to 11.34) and percutaneous coronary intervention-treated MI (OR: 14.09, 95% CI: 6.34 to 31.33). ST-segment elevation myocardial infarctions (STEMIs) and non-ST-segment elevation MIs carried distinct risks, with STEMIs increasing 90-day mortality compared to controls (OR: 2.69, 95% CI: 1.18 to 6.10). Anterior infarcts were linked to increased risk of postoperative MI, while inferior infarcts were linked to both postoperative MI and 90-day mortality. Myocardial infarction within six months, particularly type 1 MI, STEMI, percutaneous coronary intervention-treated MI, and inferior MI, carries the highest risk of postoperative MI, heart failure, and mortality.