Myocardial Infarction Within 6 Months Before Arthroscopic Rotator Cuff Repair Is Associated With Significantly Increased Risk of Postoperative Myocardial Infarction.

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.