Risk factors for early or delayed stroke after cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Neurology
• Critical Care Medicine

Background:

• Stroke is a severe complication following cardiac surgery, increasing mortality and healthcare costs.
• Identifying risk factors for perioperative stroke is crucial for patient outcomes.

Purpose of the Study:

• To identify risk factors for perioperative stroke after coronary artery bypass graft and/or valve surgery.
• To differentiate between early and delayed strokes post-cardiac surgery.

Main Methods:

• Analysis of data from 2972 patients undergoing coronary artery bypass graft and/or valve surgery.
• Preoperative carotid artery ultrasound for patients ≥65 years or with prior neurological disease.
• Intraoperative epiaortic ultrasound to detect ascending aorta atherosclerosis.
• Categorization of strokes into early (immediate post-op) and delayed (after initial recovery).

Main Results:

• 1.6% of patients (48/2972) experienced stroke, with 65% being delayed strokes.
• Independent predictors of early stroke: prior neurological event, aortic atherosclerosis, cardiopulmonary bypass duration.
• Independent predictors of delayed stroke: prior neurological event, diabetes, aortic atherosclerosis, low cardiac output, and atrial fibrillation.
• Female sex significantly increased risk for both early (6.9-fold) and delayed (1.7-fold) strokes.
• In-hospital mortality was significantly higher for patients with early (41%) and delayed (13%) strokes compared to others (3%).

Conclusions:

• The majority of perioperative strokes occur after an initial uneventful recovery.
• Female sex is a significant risk factor for both early and delayed strokes.
• Atrial fibrillation increases stroke risk only when combined with low cardiac output syndrome.