(Press-News.org) In an analysis that included more than 480,000 patients who underwent elective noncardiac surgery, a history of stroke was associated with an increased risk of major adverse cardiovascular events and death, particularly if time elapsed between stroke and surgery was less than 9 months, according to a study in the July 16 issue of JAMA.
Noncardiac surgeries performed in patients with a recent heart attack or stent implantation have been associated with increased risk of perioperative cardiac events, as well as stent thrombosis (blood clot), and bleeding compared with patients with more distant heart attack or stent placement. Whether a similar time-dependent relationship exists for stroke has not been known, and recommendations on timing of surgery in patients with prior stroke in current perioperative guidelines are sparse, according to background information in the article.
Mads E. Jørgensen, M.B., of the University of Copenhagen, Denmark, and colleagues investigated the association between prior stroke (including time elapsed between stroke and surgery) and the risk of major adverse cardiovascular events (MACE, including ischemic stroke, heart attack, and cardiovascular death) and all-cause death up to 30 days after surgery in a group of Danish patients who underwent noncardiac elective surgery (n = 481,183 surgeries) from 2005-2011.
Crude incidence rates of MACE among patients with (n = 7,137) and without (n = 474,046) prior stroke were 54.4 vs 4.1 respectively, per 1,000 patients. Further analysis indicated:
Prior ischemic stroke, irrespective of time between ischemic stroke and surgery, was associated with an adjusted 1.8- and 4.8-fold increased relative risk of 30-day mortality and 30-day MACE, respectively, compared with patients without prior stroke.
A strong time-dependent relationship between prior stroke and adverse postoperative outcome, with patients experiencing a stroke less than 3 months prior to surgery at particularly high risk. After 9 months, the associated risk appeared stable yet still increased compared with patients with no stroke.
Low- and intermediate-risk surgeries seemed to pose at least the same relative risk of MACE in patients with recent stroke compared with high-risk surgery.
"Our findings need to be confirmed but may warrant consideration in future perioperative guidelines," the authors conclude.
INFORMATION:(doi:10.1001/jama.2014.8165; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
There will also be an audio author interview available for this study at JAMA.com at the embargo time.
History of stroke linked with increased risk of adverse outcomes after non-cardiac surgery
ELSE PRESS RELEASES FROM THIS DATE:
Physicians have higher rate of organ donation registration than general public
A study that included about 15,000 physicians found that they were more likely to be registered as an organ donor compared to the general public, according to a study in the July 16 issue of JAMA. A shortage of organs for transplant has prompted many countries to encourage citizens to register ("opt in") to donate their organs and tissues when they die. However, less than 40 percent of the public is registered for organ donation in most countries with a registry. "One common fear is that physicians will not take all measures to save the life of a registered citizen at ...
Common treatment of certain autoimmune disease does not appear effective
Among patients with the systemic autoimmune disease primary Sjögren syndrome, use of hydroxychloroquine, the most frequently prescribed treatment for the disorder, did not improve symptoms during 24 weeks of treatment compared with placebo, according to a study in the July 16 issue of JAMA. Primary Sjögren syndrome is characterized by mouth and eye dryness, pain, and fatigue, with systemic manifestations occurring in approximately one-third of patients. Despite the wide use of hydroxychloroquine in clinical practice, evidence regarding its efficacy is limited, according ...
JAMA study: Telecare program optimizing non-opioid chronic pain medication very effective
INDIANAPOLIS -- Chronic pain in the back, neck and other joints due to arthritis or other musculoskeletal disorders is extremely common but difficult to treat. In a new study published in the July 16 issue of Journal of the American Medical Association, primary-care patients enrolled in a 12-month telecare program optimizing non-opioid medications for chronic pain were twice as likely to see improvement as patients who received usual care for chronic pain. In addition to experiencing pain improvement, patients in the telecare arm of the pain management study reported ...
Do daughters really cause divorce? Maybe not
DURHAM, N.C. -- In the U.S., couples with daughters are somewhat more likely to divorce than couples with sons. Many scholars have read those numbers as evidence that daughters cause divorce. But new research from Duke University suggests something quite different may be at play: Girls may be hardier than boys, even in the womb, and may be better able to survive pregnancies stressed by a troubled marriage. Previous studies have argued that fathers prefer boys and are more likely to stay in marriages that produce sons. Conversely, the argument runs, men are more likely ...
Gene discovery could lead to better soybean varieties for Northern United States
WEST LAFAYETTE, Ind. – Researchers from Purdue University and the University of Nebraska-Lincoln have discovered a soybean gene whose mutation affects plant stem growth, a finding that could lead to the development of improved soybean cultivars for the northern United States. Purdue agronomy professor Jianxin Ma (pronounced Jen-SHIN' Ma) and collaborators identified a gene known as Dt2, which causes semideterminacy in soybean plants. Semideterminate soybean plants - mid-size plants that continue vegetative growth even after flowering - can produce as many or more pods ...
Transparency lacking in clinical trials, BU study finds
A significant percentage of completed drug clinical trials, especially those funded by industry, are not disclosed to the public, years after being completed—a trend that "threatens the validity of the clinical research literature in the U.S.," according to a study led by a Boston University School of Public Health (BUSPH) researcher. The study, published in the journal PLOS ONE, found that close to 30 percent of 400 randomly selected clinical trials completed in 2008 had not resulted, four years later, in either publication in a journal or the posting of results to the ...
Do women talk more than men? It's all about context
We've all heard the stereotype: Women like to talk. We bounce ideas off each other about everything from career moves to dinner plans. We hash out big decisions through our conversations with one another and work through our emotions with discussion. At least, that's what "they" say. But is any of it actually true? A new study from Northeastern University professor David Lazer's lab says it isn't that simple. Lazer, who researches social networks and holds joint appointments in the Department of Political Science and the College of Computer and Information Sciences, ...
NASA's Van Allen Probes show how to accelerate electrons
One of the great, unanswered questions for space weather scientists is just what creates two gigantic donuts of radiation surrounding Earth, called the Van Allen radiation belts. Recent data from the Van Allen Probes -- two nearly identical spacecraft that launched in 2012 -- address this question. The inner Van Allen radiation belt is fairly stable, but the outer one changes shape, size and composition in ways that scientists don't yet perfectly understand. Some of the particles within this belt zoom along at close to light speed, but just what accelerates these particles ...
NOAA's GOES-R satellite Magnetometer ready for spacecraft integration
The Magnetometer instrument that will fly on NOAA's GOES-R satellite when it is launched in early 2016 has completed the development and testing phase and is ready to be integrated with the spacecraft. The Magnetometer will monitor magnetic field variations around the Earth and enable forecasters at NOAA's Space Weather Prediction Center to better predict the consequences of geomagnetic storms. These storms pose a threat to orbiting spacecraft and human spaceflight. In addition, the measurements taken by the Magnetometer will aid in providing alerts and warnings to power ...
For bees and flowers, tongue size matters
For bees and the flowers they pollinate, a compatible tongue length is essential to a successful relationship. Some bees and plants are very closely matched, with bee tongue sized to the flower depth. Other bee species are generalists, flitting among flower species to drink nectar and collect pollen from a diverse variety of plants. Data on tongue lengths can help ecologists understand and predict the behavior, resilience and invasiveness of bee populations. But bee tongues are hard to measure. The scarcity of reliable lingual datasets has held back research, so Ignasi ...