Impact of Preoperative STEMI on Postoperative Recovery and Complications Following Cardiac Surgery

Background: Comprehensive perioperative management strategies are advised for patients undergoing cardiac surgery who have a history of preoperative ST-segment elevation myocardial infarction (STEMI) because these patients have a higher risk for adverse postoperative outcomes. This systematic review explored the influence of preoperative STEMI on postoperative recovery and complications in cardiac surgery patients. Methods: A systematic search of PubMed, MEDLINE, EMBASE, and Cochrane Library databases was conducted following the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. Studies published between 1990 and 2024 were screened for inclusion based on predefined criteria. A total of 420 studies were initially identified, and eight studies, encompassing 1741 patients undergoing coronary artery bypass grafting (CABG), were included in the review. Two independent reviewers performed data extraction, and the quality of studies was assessed using the Newcastle–Ottawa scale. Key findings from each study were narratively synthesized to explore common themes and outcomes related to postoperative mortality, major adverse cardiac events (MACEs), and complications. Results: Of the 420 initially identified studies, eight met the inclusion criteria. Across these included studies, STEMI patients demonstrated higher postoperative mortality rates and increased incidence of MACEs compared to other cardiac surgery patients. Complications such as renal failure were particularly prevalent in patients with preoperative cardiogenic shock, with up to 50% of these patients requiring intra-aortic balloon pump (IABP) support. Recovery of left ventricular ejection fraction (LVEF) varied, ranging from 0.36 to 0.50, depending on the extent of preoperative myocardial dysfunction and the revascularization strategy employed. Variability in patient demographics, surgical techniques, and clinical settings contributed to differences in reported outcomes across studies. Conclusion: These findings underscore the importance of tailored perioperative strategies and specialized care protocols for STEMI patients undergoing cardiac surgery. By addressing the unique challenges posed by this high-risk group, healthcare providers can improve patient outcomes and reduce the incidence of postoperative complications.