Myocardial infarction following fast-track total hip and knee arthroplasty—incidence, time course, and risk factors: a prospective cohort study of 24,862 procedures

Figures & data

Figure 1. Flow of patients. DNPR = Danish National Patient Registry.

Table 1. Preoperative patient characteristics. Values are number (%) unless otherwise stated

	TKA		THA
Characteristic	11,873	(47.8)	12,989	(52.2)
Age ^a (years)	68	(10)	68	(11)
< 50	559	(4.7)	857	(6.6)
50–60	2,135	(18)	1,926	(15)
61–65	1,790	(15)	1,808	(14)
66–70	2,374	(20)	2,669	(21)
71–75	2,279	(19)	2,378	(18)
76–80	1,641	(14)	1,874	(14)
81–85	818	(6.9)	1,025	(7.9)
> 85	277	(2.3)	452	(3.5)
Female sex	7,236	(61)	7,221	(56)
BMI
< 18.5	44	(0.4)	132	(1.0)
18.5–24.9	2,305	(19)	4,411	(34)
25.0–29.9	4,528	(38)	5,309	(41)
30.0–34.9	3,118	(26)	2,335	(18)
35.0–39.9	1,298	(11)	549	(4.2)
≥ 40	524	(4.4)	172	(1.3)
Missing	56	(0.5)	81	(0.6)
Smoking	1,542	(13)	1,955	(15)
Missing	86	(0.7)	87	(0.7)
Alcohol >2 units daily	807	(6.8)	1,028	(7.9)
Missing	101	(0.9)	108	(0.8)
Social situation
Living with others	7,918	(67)	8,597	(66)
Living alone	3,858	(33)	4,246	(33)
Nursing home. etc.	53	(0.4)	104	(0.8)
Missing	44	(0.4)	42	(0.3)
Preoperative anemia^b	2,907	(25)	3,159	(24)
Missing	121	(1.0)	234	(1.8)
Use of walking aid	2,482	(21)	3,267	(25)
Missing	232	(2.0)	0	(0.0)
Hypertension	5,809	(49)	5,699	(44)
Missing	62	(0.5)	55	(0.4)
Hypercholesterolemia	4,779	(40)	4,656	(36)
Missing	70	(0.6)	69	(0.5)
Pharmacologically treated
cardiac disease	1,691	(14)	1,740	(13)
Missing	130	(1.1)	81	(0.6)
pulmonary disease	1,042	(8.8)	1,109	(8.5)
Missing	78	(0.7)	58	(0.4)
psychiatric disorder	1,053	(8.9)	1,002	(7.7)
Missing	91	(0.8)	61	(0.5)
Anticoagulant treatment ^c	745	(6.3)	777	(6.0)
Missing	0	(0.0)	0	(0.0)
Prior cerebral stroke	744	(6.3)	752	(5.8)
Missing	179	(1.5)	170	(1.3)
Diabetes
Insulin-dependent	300	(2.5)	202	(1.6)
Non-insulin-dependent	1,222	(10)	899	(6.9)
Missing	29	(0.2)	17	(0.1)

BMI = body mass index; THA = total hip arthroplasty;

TKA = total knee arthroplasty.

a mean (SD);

b Hb <13 g/dL

c Vitamin K antagonists or new oral anticoagulants.

Figure 2. Cumulated incidence of MI in 24,862 THA and TKA procedures.

Table 2. Multivariable logistic regressions for preoperative risk factors for MI within 30 days of surgery

	Model 1		Model 2		Model 3		Model 4
Variable	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Age		0.009		0.003		0.002		0.006
< 50	NA		NA		NA		NA
50–60	NA		NA		NA		NA
61–65	0.25 (0.03–2.1)	0.2	0.24 (0.03–2.0)	0.2	0.25 (0.03–2.1)	0.2	0.26 (0.03–2.2)	0.2
66–70	1	Ref	1	Ref	1	Ref	1	Ref
71–75	1.1 (0.35–3.3)	0.9	1.1 (0.36–3.4)	0.9	1.1 (0.36–3.4)	0.9	1.1 (0.35–3.3)	0.9
76–80	1.3 (0.43–4.2)	0.6	1.5 (0.47–4.5)	0.5	1.4 (0.47–4.5)	0.5	1.3 (0.43–4.2)	0.6
81–85	2.7 (0.85–8.4)	0.09	3.0 (0.94–8.3)	0.06	3.0 (0.95–9.3)	0.06	2.7 (0.85–8.5)	0.09
> 85	6.9 (2.2–21.9)	0.001	7.9 (2.5–24.7)	< 0.001	8.3 (2.6–26.3)	< 0.001	7.4 (2.3–23.5)	0.001
Male sex	1.6 (0.79–3.3)	0.2	1.8 (0.86–3.6)	0.1	1.8 (0.87–3.6)	0.1	1.6 (0.79–3.33)	0.2
Diabetes		0.04		0.03		0.07		0.07
Insulin-dependent	4.5 (1.3–15.3)	0.02	5.0 (1.5–16.7)	0.009	3.7 (1.1–12.6)	0.04	3.6 (1.1–12.4)	0.04
Non-insulin-dependent	0.69 (0.16–2.9)	0.6	1.3 (0.58–2.8)	0.6	0.59 (0.14–2.5)	0.5	0.56 (0.13–2.4)	0.4
Cardiovascular disease	2.8 (1.3–5.8)	0.006	–	–	–	–	2.4 (1.1–5.0)	0.02
Anemia ^a	1.2 (0.5–2.5)	0.7
Hypercholesterolemia	–	–	–	–	2.7 (1.3–5.9)	0.01	2.3 (1.1–5.1)	0.03
Anticoagulant treatment ^b	–	–	1.4 (0.50–4.2)	0.5	–	–	–	–

Number of patients included in analysis differs from the total number of patients due to missing data. NA: not available due to lack of data.

a Hb <13 g/dL for both men and women.

b Vitamin K antagonists or new oral anticoagulants (NOAC).

Table 3. Multivariable logistic regressions for preoperative risk factors for MI within 90 days of surgery

	Model 1		Model 2		Model 3		Model 4
Variable	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Age		< 0.001		< 0.001		< 0.001		< 0.001
< 50	NA		NA		NA		NA
50–60	0.13 (0.02–1.0)	0.05	0.12 (0.02–0.90)	0.04	0.13 (0.02–1.0)	0.05	0.14 (0.02–1.1)	0.06
61–65	0.14 (0.02–1.1)	0.06	0.13 (0.02–1.0)	0.05	0.14 (0.02–1.0)	0.06	0.14 (0.02–1.1)	0.06
66–70	1	Ref	1	Ref	1	Ref	1	Ref
71–75	0.78 (0.31–2.0)	0.6	0.81 (0.32–2.0)	0.6	0.81 (0.32–2.0)	0.6	0.78 (0.31–1.9)	0.6
76–80	1.2 (0.51–2.9)	0.7	1.3 (0.56–3.14)	0.5	1.3 (0.57–3.2)	0.5	1.2 (0.52–2.9)	0.6
81–85	2.2 (0.89–5.4)	0.09	2.5 (1.0–6.0)	0.05	2.5 (1.0–6.2)	0.04	2.3 (0.9–5.5)	0.07
> 85	5.0 (1.9–12.9)	0.001	5.9 (2.4–15.1)	< 0.001	6.3 (2.5–16.0)	< 0.001	5.5 (2.2–12.1)	< 0.001
Male sex	2.3 (1.3–4.3)	0.005	2.5 (1.4–4.5)	0.002	2.5 (1.4–4.5)	0.002	2.3 (1.3–4.1)	0.006
Diabetes		0.003		0.002		0.006		0.006
Insulin-dependent	4.4 (1.7–11.5)	0.002	5.0 (1.9–12.9)	0.001	3.9 (1.5–10.2)	0.006	3.9 (1.5–10.1)	0.006
Non-Insulin-dependent	0.42 (0.10–1.7)	0.2	0.47 (0.11–1.9)	0.3	0.38 (0.09–1.6)	0.2	0.36 (0.09–1.5)	0.2
Cardiovascular disease	3.0 (1.7–5.4)	< 0.001	–	–	–	–	2.7 (1.4–4.9)	0.001
Anemia ^a	1.2 (0.62–2.2)	0.6
Hypercholesterolemia	–	–	–	–	2.2 (1.2–4.0)	0.01	1.8 (0.99–3.4)	0.06
Anticoagulant treatment ^b	–	–	1.7 (0.73–3.7)	0.2	–	–	–	–

For footnotes, see Table 2.