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Stroke after coronary artery bypass grafting
Robert A Baker1, Lisa J Hallsworth, John L Knight
1Cardiac and Thoracic Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia. rob.baker@flinders.edu.au
The Annals of Thoracic Surgery
|October 26, 2005
Summary
Diabetes, history of stroke, and older age are key risk factors for stroke after coronary artery bypass grafting. Cardiopulmonary bypass temperature did not significantly impact stroke incidence in this study.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Stroke is a significant complication following cardiac surgery, despite advancements in surgical and cardiopulmonary bypass techniques.
- Identifying preoperative and intraoperative risk factors for perioperative stroke is crucial for patient management during coronary artery bypass graft (CABG) surgery.
Purpose of the Study:
- To identify preoperative and intraoperative risk factors associated with perioperative stroke in patients undergoing CABG surgery on cardiopulmonary bypass.
- To analyze the impact of different cardiopulmonary bypass temperature strategies on stroke incidence.
Main Methods:
- A retrospective analysis of 4,380 consecutive patients undergoing isolated CABG on cardiopulmonary bypass between 1992 and 2002.
- Patients were categorized into three cardiopulmonary bypass temperature groups: hypothermic (<31°C), tepid (32-35°C), and normothermic (>36°C).
- Stroke incidence, 30-day mortality, and length of hospital stay were the primary outcome measures.
Main Results:
- The overall stroke incidence was 1.2% (51 patients).
- Patients who experienced stroke were older, more frequently diabetic, hypertensive, had elevated creatinine levels, and a prior history of stroke (p < 0.05).
- Independent predictors for stroke included diabetes (p=0.01), history of stroke (p=0.04), and older age (p=0.05). 30-day mortality was significantly higher in stroke patients (17.6% vs 1.7%).
Conclusions:
- Diabetes, a history of stroke, and advanced age are significant risk factors for stroke after coronary artery bypass surgery.
- The temperature management during cardiopulmonary bypass was not found to be a significant predictor of stroke in this patient cohort.
- These findings underscore the importance of managing modifiable risk factors like diabetes and considering patient history in stroke prevention strategies for CABG patients.