Related Experiment Videos
Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting
R John1, A F Choudhri, A D Weinberg
1Department of Surgery, Columbia University College of Physicians and Surgeons, New York City, New York, USA. ranjitj@pol.net
Insights
Postoperative stroke after coronary revascularization significantly increases mortality and hospital stay. Key risk factors include calcified aorta, prior stroke, age, and carotid disease, informing patient selection and intervention strategies.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Public Health
Background:
- Stroke is a significant postoperative complication following coronary revascularization, occurring in 1% to 6% of patients.
- Large-scale mandatory reporting on the incidence of post-coronary revascularization stroke has been lacking.
Purpose of the Study:
- To determine the incidence of postoperative stroke after coronary revascularization.
- To identify risk factors associated with postoperative stroke in patients undergoing coronary revascularization.
Main Methods:
- Analysis of a multicenter regional database from New York State.
- Inclusion of 19,224 patients who underwent coronary revascularization in 31 hospitals during 1995.
- Utilized multivariable logistic regression to identify significant risk factors.
Main Results:
- The incidence of postoperative stroke was 1.4% (270 patients).
- Patients experiencing stroke had a 24.8% hospital mortality rate, a threefold increase in hospital stay, and identified risk factors included calcified aorta, prior stroke, advanced age, carotid arterial disease, prolonged cardiopulmonary bypass, renal failure, peripheral vascular disease, smoking, and diabetes.
- Significant risk factors identified: calcified aorta (OR 3.013), prior stroke (OR 1.909), age (OR 1.522 per 10 years), carotid arterial disease (OR 1.590), duration of cardiopulmonary bypass (OR 1.27 per 60 minutes), renal failure (OR 2.032), peripheral vascular disease (OR 1.62), cigarette smoking (OR 1.621), and diabetes mellitus (OR 1.373).
Conclusions:
- Postoperative stroke substantially elevates mortality and hospital length of stay following coronary revascularization.
- Identified risk factors, some amenable to intervention, are crucial for optimizing patient selection and management strategies before and during coronary revascularization.
Background:
Stroke complicates the postoperative course in 1% to 6% of patients undergoing coronary revascularization. There has been no large scale mandatory database reporting on the incidence of stroke after coronary revascularization.
Methods:
A multicenter regional database from the Bureau of Health Care Research Information Services, New York State Department of Health, on 19,224 patients who underwent coronary revascularization in 31 hospitals within New York State during 1995 was analyzed to determine the risk factors for postoperative stroke.
Results:
The incidence of postoperative stroke was 1.4% (n = 270). Hospital mortality for patients who had a stroke was 24.8%, compared with 2.0% for the rest of the patient population. Postoperative stroke increased the hospital length of stay threefold (27.9+/-1.9 versus 9.1+/-0.9 days, p<0.0001). Multivariable logistic regression identified the following variables to be significantly associated with a postoperative stroke: calcified aorta (p<0.0001; odds ratio [OR], 3.013), prior stroke (p = 0.0003; OR, 1.909), age (p<0.0001; OR, 1.522 per 10 years), carotid arterial disease (p = 0.002; OR, 1.590), duration of cardiopulmonary bypass (p = 0.0004; OR, 1.27 per 60 minutes), renal failure (p = 0.0062; OR, 2.032), peripheral vascular disease (p = 0.0157; OR, 1.62), cigarette smoking (p = 0.0197; OR, 1.621), and diabetes mellitus (p = 0.0158; OR, 1.373).
Conclusions:
Postoperative stroke increases mortality and length of stay after coronary revascularization. Several risk factors can be identified, and some of these factors are potentially amenable to intervention, either before or during coronary revascularization, and should also influence patient selection.