Arthroscopy - 2026-09-19 - Journal Article
Myocardial Infarction Within 6 Months Before Arthroscopic Rotator Cuff Repair Is Associated With Significantly Increased Risk of Postoperative Myocardial Infarction.
Parmar RP, Mian M, Holle AM, Amini MH, Lederman E, Patel M
Topics
Key Takeaway
Arthroscopic rotator cuff repair within 6 months of MI carries a 7.55-fold increased odds of postoperative MI compared to controls, with no significant risk elevation beyond that window.
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Summary
This study queried the PearlDiver Mariner Database (2010–2022) to determine how MI timing, type, and revascularization status affect complication risk after arthroscopic rotator cuff repair. Prior MI overall increased postoperative MI odds 3.48-fold; the 0–6 month window carried an OR of 7.55, with no significant risk elevation beyond 6 months. Type 1 MI drove postoperative MI and mortality risk, while type 2 MI was associated with acute kidney injury, pneumonia, and readmission; patients without PCI showed broader vulnerability including mortality and stiffness.
Key Limitation
Administrative coding cannot distinguish anesthesia modality (general vs. regional), which is a major independent determinant of perioperative cardiac risk and a key variable in surgical decision-making for this population.
Original Abstract
PURPOSE
To evaluate the association between myocardial infarction (MI) timing within 2 years prior to arthroscopic rotator cuff repair (aRCR) and postoperative cardiac, medical, and surgical complications.
METHODS
The PearlDiver Mariner Database (2010-2022) was queried to identify patients undergoing aRCR (CPT-29827). Patients with an MI within 2 years before surgery were propensity matched 1:4 to controls without MI based on demographics and comorbidities. Subgroup analyses evaluated MI timing (0-6, 6-12, 12-18, and 18-24 months), MI type (type 1 vs type 2, ST-elevation MI vs non-ST-elevation MI), percutaneous coronary intervention (PCI) status, guideline-directed medical therapy, and infarct location. Primary outcomes included 90-day medical and 2-year surgical complications. Odds ratios with 95% confidence intervals were calculated.
RESULTS
A total of 2886 patients with prior MI were matched to 10,613 controls. Prior MI increased the odds of postoperative MI (odds ratio, 3.48; 95% confidence interval, 2.13, 8.32). The highest risk of postoperative MI occurred when aRCR was performed within 6 months of MI (odds ratio, 7.55; 95% confidence interval, 4.38, 13.01), with no significant elevation beyond this window. Type 1 MI was associated with postoperative MI and mortality, whereas type 2 MI was associated with acute kidney injury, pneumonia, and readmission. Both ST-elevation MI and non-ST-elevation MI were linked to increased postoperative MI risk. Patients without PCI showed broader postoperative complications, including mortality, acute kidney injury, and stiffness, compared with those who underwent PCI.
CONCLUSIONS
Recent MI is associated with increased postoperative risk of MI after aRCR, particularly when surgery is performed within 6 months. Patients without PCI experience additional vulnerability.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.