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Atherosclerosis is associated with delirium after coronary artery bypass graft surgery

James L Rudolph1, Viken L Babikian, Vladimir Birjiniuk

  • 1Geriatric Research, Education, and Clinical Center, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA. jrudolph@partners.org

Journal of the American Geriatrics Society
|March 4, 2005
PubMed

Insights

Atherosclerosis in the aorta, carotid, and coronary arteries predicts delirium after coronary artery bypass graft (CABG) surgery. This finding highlights the importance of assessing atherosclerosis burden to identify patients at higher risk for postoperative delirium.

Area of Science:

  • Cardiology
  • Neurology
  • Geriatrics

Background:

  • Postoperative delirium (POD) is a common complication after cardiac surgery, particularly coronary artery bypass graft (CABG) procedures.
  • Atherosclerosis, a systemic inflammatory disease, affects multiple vascular beds and may contribute to POD through mechanisms like microembolic events or reduced cerebral perfusion.

Purpose of the Study:

  • To determine if atherosclerosis in the ascending aorta, internal carotid arteries, and coronary arteries predicts POD in patients undergoing CABG.
  • To establish an atherosclerosis score to quantify the overall burden of atherosclerotic disease.

Main Methods:

  • Prospective cohort study of 36 male veterans undergoing primary CABG surgery.
  • Assessment of carotid artery stenosis via Duplex ultrasound and ascending aortic plaque via transesophageal echocardiogram.
  • Development of an atherosclerosis score and administration of a validated delirium battery preoperatively and postoperatively.

Main Results:

  • Fifteen subjects (41.7%) developed POD.
  • Carotid stenosis (≥50%) and moderate-to-severe ascending aortic plaque were significantly associated with POD.
  • An increased atherosclerosis score was significantly associated with POD after controlling for confounders (adjusted RR=2.7, 95% CI=1.1-6.8).

Conclusions:

  • Atherosclerosis in the carotid arteries, aorta, and coronary circulation is associated with POD following CABG surgery.
  • Atherosclerosis may be a significant risk factor for POD, warranting further investigation.
  • These findings suggest that a comprehensive assessment of atherosclerosis may aid in identifying patients at increased risk for POD.
Abstract

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