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Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study
Raimondo Ascione1, Barnaby C Reeves, Martin H Chamberlain
1Bristol Heart Institute, Bristol Royal Infirmary, United Kingdom.
Insights
Stroke after coronary artery bypass grafting (CABG) is rare but serious. Key predictors include age, unstable angina, prior stroke, kidney issues, and peripheral vascular disease (PVD).
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Stroke is a rare yet severe complication following coronary artery bypass grafting (CABG).
- Prevention strategies for stroke post-CABG remain an area of active research.
- Identifying preoperative and perioperative risk factors is crucial for stroke prevention.
Purpose of the Study:
- To investigate preoperative and perioperative factors associated with stroke occurrence in patients undergoing myocardial revascularization.
- To identify independent predictors of stroke in the context of CABG surgery.
- To inform patient counseling and surgical strategy decisions.
Main Methods:
- A case-control design was employed, analyzing data from 4,077 consecutive patients undergoing CABG between April 1996 and March 2001.
- Univariate analyses were performed to identify factors associated with stroke.
- Multiple logistic regression was used to determine independent predictors of stroke, controlling for other variables.
Main Results:
- The overall incidence of perioperative stroke was 1.1% (45 out of 4,077 patients).
- Independent predictors of stroke included advanced age, unstable angina, serum creatinine > 150 mcg/ml, previous cerebrovascular accident (CVA), peripheral vascular disease (PVD), and salvage operation.
- Off-pump surgery showed a trend towards a protective effect, though not statistically significant (OR=0.56).
Conclusions:
- The incidence of stroke in this CABG cohort is relatively low.
- Specific patient factors such as age, history of CVA, PVD, elevated creatinine, and unstable angina are significant predictors of stroke.
- These identified risk factors are essential for patient risk stratification and surgical decision-making.
Background:
Stroke is a rare but devastating complication after coronary artery bypass grafting (CABG) and its prevention remains elusive. We used a case control design to investigate the extent to which preoperative and perioperative factors were associated with occurrence of stroke in a cohort of consecutive patients undergoing myocardial revascularization.
Methods:
From April 1996 to March 2001, data from 4,077 patients undergoing CABG were prospectively entered into a database. The association of preoperative and perioperative factors with stroke was investigated by univariate analyses. Factors observed to be significantly associated with stroke in these analyses were further investigated using multiple logistic regression to estimate the strength of the associations with the occurrence of stroke, after taking account of the other factors.
Results:
During the study period, 4,077 patients underwent CABG and of these 923 (22.6%) had off-pump surgery. Forty-five patients suffered a perioperative stroke (1.1%). Overall there were 46 in-hospital deaths (1.1%), of whom 6 also suffered a stroke. Brain imaging of the stroke patients showed embolic lesions in 58%, watershed in 28%, and mixed in 14%. Multivariate regression analysis identified several preoperative factors as independent predictors of stroke, ie, age, unstable angina, serum creatinine greater than 150 mcg/ml, previous cerebrovascular accident (CVA), peripheral vascular disease (PVD), and salvage operation. When operative risk factors were added to the adjusted model, off-pump surgery was associated with a substantial, but not significant, protective effect against stroke (odds ratio = 0.56, 95% confidence interval 0.20 to 1.55). Survival for stroke patients was 93% and 78% at 1 and 5 years, respectively.
Conclusions:
Overall incidence of stroke is relatively low in our series. Age, unstable angina, previous CVA, PVD, serum creatinine greater than 150 mcg/ml, and salvage operation are independent predictors of stroke. These factors should be taken into account when informing each individual patient on the possible risk of stroke and in the decision-making process on the surgical strategy.
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