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Risk factors for stroke after coronary artery bypass grafting
Dinaldo Cavalcanti de Oliveira1, Carlos Romerio Ferro, João Bosco de Oliveira
1Hospital do Coração, Associação do Sanatório Sírio, São Paulo, SP, Brasil. dinaldo@cardiol.br
Insights
Systemic hypertension and diabetes mellitus are key predictors of stroke following coronary artery bypass grafting (CABG) surgery. Identifying these risk factors can help reduce stroke incidence in patients undergoing CABG.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Public Health
Background:
- Stroke is a significant complication following coronary artery bypass grafting (CABG), occurring in 1.3-4.3% of patients.
- Identifying predictors of post-CABG stroke is crucial for improving patient outcomes in modern cardiac surgery.
Purpose of the Study:
- To determine the factors that predict stroke occurrence after CABG surgery.
- To identify modifiable and non-modifiable risk factors for stroke in the context of contemporary cardiac surgical practices.
Main Methods:
- A case-control study was conducted involving 65 pairs of patients matched for sex, age, and CABG date.
- Cases were patients who experienced stroke within 24 hours post-CABG (confirmed by imaging), while controls had no stroke after CABG with extracorporeal circulation.
Main Results:
- Univariate analysis indicated that the number of revascularized vessels was associated with stroke risk (p=0.01).
- Multivariate analysis identified systemic arterial hypertension (SAH) [OR: 6.1] and diabetes mellitus (DM) [OR: 3.1] as independent predictors of stroke.
- A history of acute myocardial infarction (AMI) over one month prior was associated with a lower chance of stroke [OR: 0.1].
Conclusions:
- Systemic hypertension and diabetes mellitus are independent predictors of early postoperative stroke after CABG.
- Understanding the mechanisms of brain injury in high-risk patients may lead to strategies for reducing stroke incidence post-CABG.
Background:
Stroke is a feared complication after coronary artery bypass grafting surgery (CABG), with an incidence between 1.3 and 4.3%.
Objective:
To identify predictive factors for stroke after CABG in the modern era of cardiac surgery.
Methods:
This is a case-control study of 65 pairs of patients, paired by sex, age (+ 3 years) and date of CABG (+ 3 months). The cases were patients submitted to elective CABG with extracorporeal circulation (ECC) that presented stroke (defined as clinical neurological deficit up to 24 hours post-operatively and confirmed by imaging assessment) and the controls were those individuals submitted to elective CABG with ECC, but without stroke.
Results:
The univariate analysis demonstrated that the number of revascularized vessels was associated with the occurrence of stroke after the CABG (3 +/- 0.8 vs. 2.76 +/- 0.8, p = 0.01). The multivariate analysis by conditional logistic regression showed that systemic arterial hypertension (SAH) [OR: 6.1 (1.5 - 24), p = 0.009] and diabetes mellitus (DM) [OR: 3.1 (1.09 - 11), p= 0.03] were the determinants of the highest chance of stroke after CABG, whereas acute myocardial infarction (AMI) > 1 month, was the determinant of the lowest chance of stroke [OR: 0.1 (0.03 - 0.36), p = 0.003].
Conclusion:
Hypertension and diabetes mellitus were identified as independent predictors of stroke within the first 24 postoperative hours after CABG. In patients with such risk factors, it is possible that the knowledge of the causal mechanisms of brain injury represents a strategy capable of decreasing the incidence of stroke after CABG.
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