Once a person has experienced a stroke, risk for future cardiovascular events remains substantially elevated compared to a healthy population.
The perioperative period is known to be a time of increased risk for major adverse cardiovascular events (MACE), and it would be valuable to know the interval after which surgical procedures could be performed with minimum risk of MACE for stroke survivors: Is an operation safe 3 months after a stroke? 6 months? 1 year?
Jørgensen et al evaluated data from the Danish Nationwide Cohort Study (n = 481,183 elective noncardiac surgeries in adults) to examine the relative risk for MACE in the general population vs stroke survivors. Even distant from the event, risk for MACE was greater in stroke survivors compared to the healthy population (odds ratio [OR] = 1.46). Additionally, the risk of perioperative MACE was greatest in the time period most proximate to the stroke: OR was as high as 14.2 if surgery occurred within 3 months of stroke, reduced to 4.85 in the 3-6 months post-stroke interval, and reduced further to an OR of 2.47 if surgery was performed at least 12 months post-event. These data should provide impetus to advise stroke survivors that unless there is some urgency to an elective procedure, cardiovascular outcomes are best when elective surgery is performed at least 12 months from the date of the index event.
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