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<h4>Background</h4>The incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is <1%. When patients with chronic kidney disease (CKD) undergo orthopedic surgery, AMI incidence can be expected to be relatively high. However, data on a population-wide scale is lacking.<h4>Objective</h4>To investigate AMI incidence in patients with CKD (with and without dialysis) undergoing orthopedic surgery.<h4>Design</h4>A population-based study covering the period from January 1, 1997, to December 31, 2011.<h4>Setting</h4>Data from the Taiwan National Health Insurance Research Database.<h4>Participants</h4>Participants were 219,195 patients with CKD who underwent surgery between January 1, 1997, and December 31, 2011.<h4>Results</h4>AMI occurred in 2,708 participants (1.24%). The AMI incidence rate in the dialyzed group was 1.52%, which was higher than that in the nondialyzed group after propensity score matching. Dialysis (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.62-1.98), male (OR: 1.42; 95% CI: 1.28-1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44-1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68-2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26-1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30-1.47) were all associated with AMI in the patients with CKD.<h4>Conclusions</h4>The AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group.