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Predictors of stroke in patients undergoing coronary artery bypass grafting surgery: a prospective, nested,
Scott E Woods1, J Michael Smith, Amy Engle
1Bethesda Family Medicine Residency Program, Cincinnati, Ohio 45212, USA. liverdoctor@yahoo.com
Insights
Older age, poor preoperative neurologic status, and prior cardiac surgery significantly increase stroke risk in patients undergoing coronary artery bypass grafting (CABG). These factors are crucial for identifying high-risk individuals before CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Public Health
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
- Stroke is a significant complication following CABG, impacting patient outcomes and healthcare costs.
- Identifying risk factors for stroke after CABG is crucial for preventive strategies.
Purpose of the Study:
- To assess the risk factors for stroke in patients undergoing coronary artery bypass grafting (CABG) surgery.
- To identify independent predictors of stroke in the CABG population.
Main Methods:
- A nested case-control study was conducted using a 9-year prospective hospitalization cohort of 6245 patients.
- Cases were patients who experienced a stroke post-CABG (n=171), matched with controls without stroke (n=513) at a 1:3 ratio.
- 39 potential predictor variables were analyzed using regression analysis to identify independent predictors of stroke.
Main Results:
- Age over 70 years was a significant predictor of stroke (OR, 4.61; 95% CI, 2.84-6.07).
- Poor preoperative neurologic status was also a strong independent predictor (OR, 4.24; 95% CI, 2.02-5.79).
- Previous cardiac surgery independently predicted stroke risk (OR, 1.75; 95% CI, 1.05-2.91).
Conclusions:
- Age >70 years, poor preoperative neurologic status, and previous cardiac surgery are independent predictors of stroke in CABG patients.
- These findings can aid in risk stratification and the development of targeted interventions to reduce stroke incidence after CABG.
- Further research may explore specific interventions to mitigate these identified risks.
Abstract:
The objective of the present study was to assess the risk factors for stroke in patients undergoing coronary artery bypass grafting (CABG) surgery. We conducted a nested case-control study from a 9-year, prospective hospitalization cohort (n = 6245). Inclusion in the cohort included CABG between October 1993 and June 2002. Exclusion criteria included any other simultaneously performed surgery. Cases were defined as patients who underwent CABG and experienced a stroke (171 cases, 2.7% of the total), and controls were patients who underwent CABG without a stroke. Cases were matched to controls at a ratio of 1:3 (513 controls). The 39 predictor variables were pump time, body surface area, creatinine, previous percutaneous transcoronary angioplasty (PTCA), clamp time, coronary perfusion time, previous cardiac surgeries, hypertension, race, sex, previous myocardial infarction, family history of coronary disease, history of cerebrovascular disease, preoperative neurologic disease, pulmonary hypertension, aortic disease, previous intervention within 30 days, angina history, bleeding history, previous vascular surgery, diabetes, age, myocardial findings, chronic obstructive pulmonary disease, New York Heart Association class, previous gastrointestinal disease, current vascular disease, systemic diseases, vessels at last PTCA, PTCA result, current smoking, tobacco history, dialysis, current anticoagulant therapy, character of operation, left ventricular hypertrophy, hypercholesterolemia, and chronic corticosteroid therapy. There were 13 significant predictors of stroke. Regression analysis revealed 3 independent predictors of stroke: age >70 years (odds ratio [OR], 4.61; 95% confidence interval [CI], 2.84-6.07), poor preoperative neurologic status (OR, 4.24; 95% CI, 2.02-5.79), and previous cardiac surgery (OR, 1.75; 95% CI, 1.05-2.91). We conclude that in patients undergoing CABG surgery, the independent predictors for stroke, in order of risk, are age >70 years, poor preoperative neurologic status, and previous cardiac surgery.
