Ophthalmologic procedures are not associated with increased risk for acute myocardial infarction

1. Based on the study, there was no evidence of increased risk for acute myocardial infarction after an ophthalmologic procedure.

2. Outpatient ophthalmologic procedures, even when stratified on type of surgery and anesthesia, were not associated with an increased risk for acute myocardial infarction.

Evidence Rating Level: 2 (Good)

Study Rundown: Invasive surgical procedures represent physiological stressors for patients and can cause inflammation as well as immobility, which increases the risk of plaque rupture, increased platelet aggregability, and decreased fibrinolysis that can precipitate an acute myocardial infarction (AMI). Ophthalmologic procedures, done in outpatient settings, are generally less invasive, yet previous cohort studies have suggested temporal associations between ophthalmologic procedures and AMI. However, they were not designed to study the effects of transient exposures. Therefore, there is a gap in knowledge as to understanding whether ambulatory ophthalmologic procedures lead to the increased onset of AMI. This study found that ophthalmologic procedures done in an outpatient setting were not associated with an increased risk for AMI. This study was limited by factors such as potential bias from time-varying confounders between the hazard and control periods. Nevertheless, these study’s findings are significant, as they demonstrate that outpatient ophthalmologic procedures are not associated with a higher risk for AMI, and seem to be safe in general.

Click to read the study in AIM

Relevant Reading: Summary for Patients: Risk for Heart Attack After Eye Procedures

In-Depth [case-crossover study]: This case-crossover study utilized a population-based nationwide study from Norway and Sweden, with patients receiving outpatient ophthalmologic procedures in Norway from 2008 to 2014 or in Sweden from 2001 to 2014. Patients who were 40 years or older, with a primary diagnosis of ICD codes I21 or I22 between March 2008 and December 2016 in Norway, or between March 2001 and December 2014 in Sweden were eligible for the study. Patients who received ophthalmologic procedures outside of this time frame were excluded from the study. The primary outcome measured was exposure to ophthalmologic procedures in the 0 to 7 days before AMI diagnosis, compared with an 8-day period 30 days earlier before AMI (control week), to estimate the relative risk for an AMI the week after an ophthalmologic procedure. Outcomes in the primary analysis were assessed via conditional logistic regression. Based on the analysis, there was a lower risk of AMI in the week after an ophthalmologic procedure than during the control week (Odds Ratio 0.83, 95% Confidence Interval, 0.75 to 0.91). There was also no evidence of increased risk for AMI even when patients were stratified by surgery subtype, type of anesthesia, duration, invasiveness (low, intermediate, or high), age, or preexisting comorbidities. Overall, this study demonstrated that ophthalmologic procedures are not associated with an increased risk of AMI, and show that these outpatient procedures are generally safe, though preventive strategies to decrease excess risk should still be taken.

Image: PD

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