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Published on: March 27, 2018
Predictors of cognitive decline following coronary artery bypass graft surgery
P Michael Ho1, David B Arciniegas, Jim Grigsby
1Denver Veterans Affairs Medical Center, Denver, Colorado, USA. michael.ho@uchsc.edu
Insights
Cognitive decline after coronary artery bypass grafting (CABG) is linked to cerebrovascular disease, chronic neurologic illness, and living alone. Higher education and shorter cardiopulmonary bypass times may reduce this risk.
Area of Science:
- Neurosurgery
- Cardiology
- Gerontology
Background:
- Cognitive impairment is a common, persistent issue for patients post-coronary artery bypass grafting (CABG).
- Identifying risk factors for this decline is crucial for patient management.
Purpose of the Study:
- To identify patient-related risk factors for cognitive decline after CABG.
- To investigate the role of perioperative complications in post-CABG cognitive impairment.
Main Methods:
- 939 patients undergoing CABG-only surgery were assessed using cognitive tests at baseline and 6 months.
- Multiple linear regression analysis identified predictors of cognitive decline at 6 months post-surgery.
Main Results:
- Cerebrovascular disease, peripheral vascular disease, chronic neurologic illness, and living alone were associated with cognitive decline.
- Increased years of education were inversely related to cognitive decline.
- Postoperative complications and longer cardiopulmonary bypass times were linked to cognitive decline.
Conclusions:
- Patients with atherosclerosis complications, chronic neurological conditions, or limited social support face higher risks of cognitive decline post-CABG.
- Higher education levels correlate with a lower risk of cognitive decline.
- Preoperative risk factor assessment can aid in patient counseling regarding cognitive risks after CABG.
Background:
A significant number of patients develop cognitive impairment that persists for months following coronary artery bypass grafting (CABG) surgery. Our objectives were to identify patient-related risk factors, processes of care, and the occurrence of any perioperative complications associated with cognitive decline.
Methods:
Nine hundred thirty-nine patients enrolled in the Processes, Structures, and Outcomes of Care in Cardiac Surgery study undergoing CABG-only surgery at 14 Veterans Administration medical centers between 1992 and 1996 completed a short battery of cognitive tests at baseline and 6-months post-CABG. The composite cognitive score was based on the sum of errors for each individual item in the battery. Multiple linear regression analyses were used to identify independent predictors of the 6-month composite cognitive score.
Results:
In multivariable analyses, patient characteristics associated with cognitive decline included cerebrovascular disease (p = 0.009), peripheral vascular disease (p = 0.007), history of chronic disabling neurologic illness (p = 0.016), and living alone (p = 0.049), while the number of years of education (p = 0.001) was inversely related to cognitive decline. After adjustment for baseline patient risk factors, the presence of any postoperative complication(s) (p = 0.001) was also associated with cognitive decline while cardiopulmonary bypass time (p = 0.008) was inversely related to cognitive decline.
Conclusions:
Patients with noncoronary manifestations of atherosclerosis, chronic disabling neurologic illness, or limited social support are at risk for cognitive decline after CABG surgery. In contrast, more years of education were associated with less cognitive decline. Preoperative assessment of risk factors identified in this study may be useful when counseling patients about the risk for cognitive decline following CABG surgery.
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