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Four percent of all patients undergoing surgery have a history of stroke, but international perioperative guidelines do not address this topic. We examined the importance of stroke for major adverse cardiovascular events (MACE) in a nationwide cohort of patients undergoing elective surgery.
Patients were identified in the Danish National Patient Register. Crude incidence rates and adjusted Cox proportional-hazard regression were used to study risk of MACE (myocardial infarction, stroke or cardiovascular death).
Of 474,637 operations on 368,643 patients between 1997-2011, 18,076 (4%) were performed on patients with a history of stroke. The incidence of MACE within 7 or 30 days and all-cause death within 7 and 30 days was 650, 1452, 1001 and 3180, respectively. Unadjusted incidence rates for patients without stroke were 5, 12, 9 and 29 events per 100 person-years, for the four outcomes, respectively, compared to 170, 310, 140 and 370 for patients with a stroke within 3 months prior to surgery. The adjusted Cox regression models revealed increased risk of all endpoints in patients with prior stroke (Figure), in particular there was high risk for those with stroke within 3 months.
Stroke is a major risk factor for adverse outcomes and death following surgery, especially if time since stroke is less than 3 months. Inclusion of prior stroke in perioperative risk estimation should therefore be considered.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Prevention: Cardiovascular Risk Factors
Abstract Category: 24. Prevention: Clinical
Presentation Number: 1146M-11
- 2013 American College of Cardiology Foundation