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Risk factors for stroke following coronary artery bypass operations
Mehmet Ali Ozatik1, Mehmet Kamil Göl, Iyad Fansa
1Türkiye Yüksek Ihtisas Eğitim ve Araştirma Hospital, Cardiovascular Surgery Clinic, Ankara, Turkey. maozatik@yahoo.com
Insights
Stroke after coronary artery bypass surgery remains a concern. Key risk factors include older age, female sex, hypertension, and specific heart and vascular conditions. Preoperative carotid evaluation and intraoperative echocardiography may reduce stroke incidence.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Medicine
Background:
- Stroke remains a significant complication following coronary artery bypass surgery (CABG).
- This study investigates risk factors for stroke in CABG patients over an 8-year period.
Purpose of the Study:
- To identify and evaluate risk factors associated with stroke development after coronary artery bypass surgery.
- To analyze the impact of specific interventions on stroke rates.
Main Methods:
- Retrospective analysis of 8547 coronary artery bypass operations performed between 1995 and 2003.
- Identification of 75 patients (0.9%) who experienced early postoperative stroke.
- Statistical analysis including univariate and logistic regression to determine risk factors.
Main Results:
- Stroke rates decreased from 1.2% (1995-1998) to 0.7% (1998-2003) with the introduction of carotid Doppler and epiaortic echocardiography.
- Independent risk factors for stroke included advanced age, left main coronary artery disease, peripheral vascular disease, and earlier operation dates (pre-1998).
- Mortality after stroke was associated with female sex and preoperative hypertension.
Conclusions:
- Stroke is a major cause of mortality post-CABG.
- Proactive measures, including preoperative carotid artery evaluation and intraoperative epiaortic echocardiography, are crucial for stroke prevention.
- Identifying and managing patients with risk factors is essential to mitigate stroke complications.
Background:
Although the overall complication rates have been decreased significantly in recent years, stroke rates still remain high in patients undergoing coronary bypass operations. This study is designed to evaluate the risk factors for stroke in patients who had undergone coronary artery bypass surgery in an 8-year period in our clinic.
Methods:
Between 1995 and 2003, 8547 coronary artery operations under cardiopulmonary bypass were performed. Retrospective analysis of the patient files revealed that 75 (0.9%) patients had stroke in the early postoperative period.
Results:
Mean age of these patients was 62.3 +/- 9.5 years, and 54 (72%) were males. Stroke rate was 1.2% between 1995 and 1998 and this was significantly higher from the stroke rate (0.7%) of the period 1998 to 2003 (p = 0.03). Major technical differences between these two periods were the routine application of preoperative carotid arteries Doppler evaluation and intraoperative epiaortic echocardiography after 1998. Higher age (p = 0.000), female sex (p = 0.005), smoking (p = 0.03), presence of diabetes mellitus (p = 0.01), hypertension (p = 0.008), and left main coronary artery disease (p = 0.001), carotid surgery (p = 0.000), and peripheral vascular disease (p = 0.049) were identified as important risk factors in univariate analysis for stroke development. Higher age (p = 0.000; OR = 21.38), left main coronary artery disease (p = 0.007; OR = 7.26), peripheral vascular disease (p = 0.050; OR = 3.08), and operation date before 1998 (p = 0.012; OR = 6.33) were identified as important risk factors in logistic regression analysis. According to intraoperative epiaortic ultrasonography, operative strategy was changed in 9% of patients. Thirty-seven (49.3%) of the stroke patients died. Female sex (p = 0.023; OR = 5.18) and preoperative hypertension (p = 0.045; OR = 4.03) were observed as significant risk factors for mortality after stroke.
Conclusion:
Development of stroke is one of the major reasons of mortality after coronary artery bypass operations. It is essential to take all the measures to prevent this complication, especially in patients with known risk factors. Evaluation of carotid arteries prior to operation and application of routine intraoperative epiaortic echocardiography may in part eliminate stroke.
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