Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures.

Background and objectives: Previous studies reported a predisposition to major adverse cardiovascular or cerebrovascular events (MACCE) in patients consuming cannabis, which might be exacerbated by interventional or surgical procedures. This study investigated the association of nonmedical cannabis use with MACCE after interventional procedures or surgery.

Methods: 288,923 adult patients undergoing noncardiac surgery between 2008 and 2020 at a tertiary academic hospital in Massachusetts, United States, were included. The exposure was nonmedical use of cannabis, differentiated into ongoing self-reported recreational use or a diagnosis of cannabis use disorder. The primary outcome was MACCE, defined as ischemic stroke, cardiac arrest, acute heart failure, myocardial infarction, or revascularization within 1 year.

Results: Patients with a diagnosis of cannabis use disorder had a higher risk of MACCE (adjusted odds ratio 1.26; 95%CI 1.05-1.51; p = .02). For recreational users, this was dependent on the patient's baseline cardiac risk, based on the revised cardiac risk index (RCRI) class: among patients at high cardiac risk (RCRI class III/IV), recreational cannabis use was associated with increased risk (adjusted odds ratio 1.41; 1.15-1.74; p = .001), while there was no association among patients with a low RCRI class (I/II; adjusted odds ratio 0.87; 0.75-1.02; p = .09).

Discussion and conclusions: Patients with a diagnosed cannabis use disorder are at increased risk of post-procedural MACCE, while for recreational users, this association was dependent on patients' baseline cardiac risk.

Scientific significance: This study demonstrates the association between cannabis use and MACCE differentiated by type of use and depending on baseline cardiac risk.