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Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass

Farzan Filsoufi1, Parwis B Rahmanian, Javier G Castillo

  • 1Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA. farzan.filsoufi@mountsinai.org

The Annals of Thoracic Surgery
|February 23, 2008
PubMed

Insights

Stroke after coronary artery bypass grafting (CABG) often occurs early and is linked to higher mortality. Identifying risk factors like aortic calcification and prior stroke is crucial for prevention.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Radiology

Background:

  • Limited data exists on the timing and brain imaging findings of stroke following coronary artery bypass grafting (CABG).
  • Understanding stroke etiology post-CABG is vital for developing preventive strategies.
  • This study investigates stroke incidence, timing, lesion characteristics, predictors, and outcomes after CABG.

Purpose of the Study:

  • To analyze the incidence and timing of stroke after CABG.
  • To determine the topography and mechanisms of cerebral lesions.
  • To identify independent predictors and assess the late outcome of stroke post-CABG.

Main Methods:

  • Retrospective analysis of prospectively collected data from 2985 patients undergoing CABG (1998-2006).
  • Stroke defined as new permanent focal neurologic deficit; categorized as early (<=24 hours) or delayed (>24 hours).
  • Brain imaging (CT/MRI) performed in 92% of stroke patients; multivariate analysis used to identify predictors.

Main Results:

  • Stroke incidence was 1.6%, with no significant difference between conventional and off-pump CABG.
  • Early stroke (< or = 24 hours) occurred in 52% of cases, predominantly large embolic strokes (76%).
  • Predictors included aortic calcification (OR 4.2), prior stroke (OR 2.2), female sex (OR 1.9), and heart failure (OR 2.6).
  • Hospital mortality was 16.7% post-stroke vs. 1.5% without stroke (p < 0.001).
  • One-year and five-year survival rates were significantly reduced in stroke patients (87%/62%) compared to non-stroke patients (96%/85%).

Conclusions:

  • Most strokes post-CABG occur early and are associated with increased mortality and reduced long-term survival.
  • Infarction type did not impact early or late outcomes.
  • Preoperative CT scans are recommended for high-risk patients without a history of stroke.
Abstract

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