How Common Are Strokes During and After Cardiac Surgery?

Individuals who undergo cardiac surgery have a 1% risk for experiencing either an early or delayed stroke, according to new research. And while both types of stroke reduce long-term survival, it is early stroke that has a worse association with operative mortality.

“This is the first systematic review and meta‐analysis to examine the incidence of early and delayed stroke after cardiac operations,” the researchers wrote.

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To review the incidence, risk factors, and clinical outcome of early strokes (detected upon awakening or after extubation) and delayed strokes (detected after a normal awakening from anesthesia) following cardiac surgery, the researchers identified 36 articles that had reported such events from across 3 databases. In all, the articles included data from 174,969 patients.

The pooled event rate was 0.98% for early stroke and 0.93% for delayed stoke. Meanwhile, the pooled event rate of operative mortality was 28.8% for early stroke and 17.9% for delayed stroke. For comparison, patients who had cardiac surgery but did not have a stroke had an operative mortality rate of 2.4%.

Patients included in the review who did not have a stroke also had a 3.4% incident rate of late mortality at a mean follow-up of 8.25 years. The rate was greater among those with early stroke (11.7%) vs those with delayed stroke (9.4%).

The researchers also determined that while off-pump coronary artery bypass graft and early stroke were inversely related, previous stroke and delayed stroke were associated. Because early stroke is not associated with any patient‐level risk factors, this type of stroke may be caused by a technical or surgical complication, according to the review authors. 

“Continued targeted interventions to reduce the burden of both early and delayed strokes are imperative to improve overall surgical outcomes,” the review authors concluded.

—Colleen Murphy

Reference:

Gaudino M, Rahouma M, Di Mauro M, et al. Early versus delayed stroke after cardiac surgery: a systematic review and meta‐analysis. J Am Heart Assoc. 2019;8(13). doi:10.1161/JAHA.119.012447.