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To the Editor: The Comment section in the study by Dr Wu and colleagues¹ did not discuss the observed association between myocardial infarction (MI) in the 6 months prior to surgery and 30-day postoperative mortality (odds ratio, 2.84; 95% confidence interval, 2.56-3.15). Although MI in the 6 months prior to surgery has been recognized as a risk factor for reinfarction and perioperative mortality,² it is absent in current guidelines.³ These guidelines define a "recent" MI as having occurred more than 7 days but less than 1 month before surgery, implying that the risk associated with an MI that occurred more than a month prior to surgery is no longer considered to be significant and does not require specific management.

It is possible to attribute the increased perioperative mortality observed in patients with MI within 6 months to decreased cardiac reserve in the presence of anemia, as suggested by the authors. . . . [Full Text of this Article]

Edward C. Nemergut, MD
en3x@virginia.edu

Keith E. Littlewood, MD; Duncan G. de Souza, MD
Department of Anesthesiology
University of Virginia Health System
Charlottesville

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