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Heart attack risk rises after hip replacement

Huge rise in MI risk soon after knee or hip surgery, especially for over-80s

Louise Prime

Tuesday, 24 July 2012

Patients are at hugely greater than usual risk of having a heart attack in the first fortnight after hip or knee replacement, warn researchers. They have called for much more to be done to reduce these patients’ risks in the period after surgery.

Researchers used 10 years’ data from Danish national registries to compare the rate of acute myocardial infarction (AMI) in 95,227 people who had undergone total hip replacement (THR) or total knee replacement (TKR) surgery, with the AMI rate among 286,165 matched controls.

Their study, published online today in Archives of Internal Medicine, showed that the risk of AMI within two weeks of THR was 25 times that seen in matched controls; for TKR, it was 31 times higher than in controls for the first fortnight. This association was especially strong in patients at least 80 years old, and was not significant in the under-60s.

After the first two weeks, the risk declined sharply, but it remained significantly elevated for six weeks after THR surgery. The absolute risk of AMI was 0.51% within six weeks of THR surgery, and 0.21% for TKR surgery.

The researchers said: “A previous AMI in the six months before surgery increased the risk of new AMI during the first six weeks after THR and TKR (4-fold increase) surgery but did not modify the relationship between THR or TKR and AMI.”

The author of an accompanying commentary wrote: “The perioperative period is stressful to patients … The present study once again confirms that the perioperative period increases cardiac risk. Physicians must go further than establishing risk factors; physicians must actively work to reduce perioperative risk.”

He continued: “It is important for physicians caring for patients in the perioperative period to recognise the potential for cardiac morbidity and mortality and then appropriately use the armamentarium of medical therapies we now have to reduce cardiac risk, prevent perioperative MIs, and prevent cardiac deaths.”

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