Racial Differences in Outcomes After Perioperative Myocardial Infarction: A Multicenter Analysis of Noncardiac Surgical Patients.

BACKGROUND

Perioperative myocardial infarction (PMI) is a common cardiovascular complication following noncardiac surgery and is associated with significant morbidity and mortality. However, data on racial disparities in outcomes remain limited. This study evaluates racial differences and complications among patients who experience PMI following moderate- to high-risk noncardiac surgery.

METHODS

We analyzed the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent moderate- to high-risk noncardiac surgeries between 2010 and 2020. Demographic and clinical variables were compared across racial groups. Multivariable logistic regression was used to assess the impact of race on 30-day mortality and postoperative complications after adjusting for preoperative comorbidities and perioperative risk factors.

RESULTS

Among 23,273 patients with PMI, the overall 30-day mortality rate was approximately 20% and did not differ significantly by race (P = .33). After adjustment for other covariables, Black race was independently associated with higher odds of acute renal failure (OR: 1.511; CI: 1.277-1.789; P < .0001), prolonged postoperative mechanical ventilation for > 48 h (OR: 1.312; CI: 1.169-1.471; P < .0001), pulmonary embolism (OR: 1.659; CI: 1.322-2.081; P < .0001), cardiac arrest requiring cardiopulmonary resuscitation (OR: 1.428; CI: 1.252-1.629; P < .0001), and return to the operating room (OR: 1.228; 95% CI: 1.097-1.374; P = .0017). Black patients also experienced longer hospital stays (IRR: 1.087; 95% CI: 1.027-1.151; P < .0001).

CONCLUSION

While 30-day mortality following PMI did not differ by race, Black patients experienced increased postoperative morbidities. These findings underscore the need for targeted perioperative interventions to mitigate racial disparities in postoperative outcomes.