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Perioperative stroke in coronary artery bypass surgery. Analysis of risk factors
1Department of Cardiothoracic Surgery, Helsinki University Hospital, Finland.
Insights
Identifying stroke risk after coronary bypass surgery is crucial. Key predictors include patient age, renal failure, cerebrovascular disease, peripheral vascular disease, and specific surgical factors.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Neurologic complications after coronary artery bypass grafting (CABG) are increasing.
- Older and sicker patients are undergoing CABG, raising concern for adverse outcomes.
Purpose of the Study:
- To identify predictive factors for stroke after first-time coronary artery bypass grafting.
- To aid in identifying high-risk patients requiring special attention.
Main Methods:
- Retrospective review of 2263 consecutive first-time CABG cases (1993-1995).
- Univariate and multivariate analyses were performed to identify significant risk factors for stroke.
Main Results:
- Significant univariate predictors included age, peripheral vascular disease, cerebrovascular disease, renal failure, aortic aneurysm/stenosis, urgent operation, NYHA class, bypass time, anastomoses, ascending aorta atheromatosis, venting, balloon counterpulsation, reoperation, and perioperative myocardial infarction.
- Multivariate analysis confirmed age, renal failure, cerebrovascular disease, peripheral vascular disease, NYHA class, number of aortic anastomoses, perioperative myocardial infarction, and ascending aorta atheromatosis as significant predictors.
Conclusions:
- Several patient-related and intraoperative factors significantly predict stroke risk following CABG.
- Identifying these factors can help stratify risk and potentially guide preventative strategies.
Abstract:
The incidence of neurologic complications after coronary bypass surgery is steadily rising as older and sicker patients are increasingly being treated. To identify patients requiring special attention, we reviewed the records in 2263 consecutive cases of first-time coronary artery bypass grafting in 1993-1995, in order to find predictive factors for stroke. Significant factors in univariate analysis were patient age, peripheral vascular disease, cerebrovascular disease, renal failure (defined as serum creatinine > or = 150 micromol/l), aneurysmal disease of the abdominal aorta, stenosis of the left main coronary artery, urgent or emergency operation, NYHA class, cardiopulmonary bypass time, number of aortic anastomoses, intraoperatively detected loose or calcified atheromatosis of the ascending aorta, left ventricular venting, intra-aortic balloon counterpulsation, cardiac complications necessitating early reoperation, and perioperative myocardial infarction. In a multivariate analysis, age, renal failure, cerebrovascular disease, peripheral vascular disease, NYHA class, number of aortic anastomoses, perioperative myocardial infarction and intraoperatively detected loose atheromatosis of the ascending aorta remained significant.