Myocardial Infarction Within 6 Months before Total Shoulder Arthroplasty is Strongly Associated with Postoperative Complications.

BACKGROUND

As total shoulder arthroplasty (TSA) is increasing in volume, limited data exist regarding how recent myocardial infarction (MI) influences postoperative outcomes. This study aimed to evaluate the impact of MI timing, type, treatment, and anatomical location on rates of postoperative cardiac, medical, and surgical complications following TSA.

METHODS

A national insurance database, PearlDiver, was queried to identify patients with a history of MI within two years prior to TSA. These patients were propensity-matched 1:4 to controls without prior MI based on demographics and comorbidities. The MI cohort was stratified by timing (0-6 months, 6-12 months, 12-18 months, 18-24 months), and subgroup analyses were performed by MI type (Type 1 vs. Type 2), ST-Segment Elevation Myocardial Infarction (STEMI) vs Non-ST-Elevation Myocardial Infarction (NSTEMI) classification, percutaneous coronary intervention (PCI), guideline-directed medical therapy (GDMT), and infarct location.

RESULTS

A history of MI within 2 years preceding TSA had a strong association with higher odds of postoperative MI (OR 5.67; 95% CI, 3.86-8.32). The strongest association was observed when MI occurred within 6 months of TSA (OR 9.95; 95% CI, 6.50-15.24). Type 1 MI was strongly associated with postoperative MI, particularly within 6 months (OR 10.86; 95% CI, 6.96-16.95). Type 2 MI within 6 months was strongly associated with postoperative MI (OR 10.69; 95% CI, 2.50-45.63), DVT (OR 9.81; 95% CI, 2.30-41.79), and PJI (OR 5.24; 95% CI, 1.60-17.18). Both STEMI (OR = 6.17) and NSTEMI (OR = 5.77) were strongly associated with postoperative MI. Anterior MI was strongly associated with postoperative MI (OR 7.22; 95% CI, 3.36-15.49), whereas inferior MI was strongly associated with 90-day mortality (OR 6.46; 95% CI, 1.85-22.60).

CONCLUSION

MI within 2 years and specifically 6 months of TSA was associated with higher odds of postoperative complications. MI timing, subtype, treatment, and location should be carefully weighed when considering TSA in this high-risk population.