OPERATIVE FACTORS AND THE LONG-TERM INCIDENCE OF ACUTE MYOCARDIAL-INFARCTION AFTER TRANSURETHRAL RESECTION OF THE PROSTATE

We studied the association between the operative course of transurethr al resection of the prostate (TURP) and the morbidity of acute myocard ial infarction (AMI) in a cohort comprising 846 patients who underwent this operation between 1983 and 1992. Up to the end of 1993, a total of 69 patients had developed AMI, of which 10 patients had a reinfarct ion. The relative risk associated with absorption of 500 ml or more of the irrigating medium during surgery was 1.6 [95% confidence interval (CI) = 0.9-3.0] for a first-time AMI after TURP, 6.1 (95% CI = 1.8-20 .7) for a reinfarction, and 2.2 (95% CI = 1.3-3.9) for a first-time or a reinfarction combined. A blood loss of 275 ml or more was associate d with a decreased relative risk (RR = 0.4; 95% CI = 0.2-0.8) of a fir st-time AMI after TURP. Patients who lost less than 275 ml of blood an d absorbed 500 ml or more of irrigating fluid during surgery had 4.4 t imes the risk of having an acute myocardial infarction (RR = 4.4; 95% CI = 1.7-11.8). These results appear to indicate that the operative co urse of TURF is important to the development of AMI over an extended p eriod of time.