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Temporal pattern of strokes after on-pump and off-pump coronary artery bypass graft surgery
Kei Nishiyama1, Masahito Horiguchi, Satoshi Shizuta
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. keinishi@kuhp.kyoto-u.ac.jp
Insights
Off-pump coronary artery bypass graft (CABG) surgery significantly reduces early stroke risk compared to on-pump procedures. However, the risk of delayed strokes remains similar between both surgical methods.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Clinical Outcomes
Background:
- Stroke incidence remains a concern following coronary artery bypass graft (CABG) surgery.
- Understanding stroke risk factors and temporal patterns is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and risk factors of strokes after on-pump and off-pump CABG.
- To analyze the temporal pattern of strokes, differentiating between early and delayed onset.
Main Methods:
- Analysis of 2,516 patients undergoing first elective isolated CABG.
- Primary endpoint: strokes within 30 days post-surgery.
- Classification of stroke onset as 'early' (immediate post-anesthesia) or 'delayed' (after initial recovery).
Main Results:
- Over half of strokes (63%) were classified as delayed.
- Off-pump CABG showed a significantly lower risk of early stroke (0.1% vs. 1.1%).
- No significant difference in delayed stroke incidence between on-pump and off-pump CABG (0.9% vs. 1.4%).
- Off-pump CABG was an independent protective factor for all and early strokes, but not delayed strokes.
Conclusions:
- Off-pump CABG reduces perioperative stroke incidence primarily by decreasing early strokes.
- The risk of delayed strokes is comparable between on-pump and off-pump CABG procedures.
Background:
The incidence of strokes has not decreased after coronary artery bypass graft surgery (CABG). The purpose of this study is to identify incidence, risk factors, and temporal pattern of strokes after on-pump and off-pump CABG.
Methods:
We analyzed 2,516 consecutive patients who underwent first elective isolated CABG. The primary endpoint was strokes within 30 days. The temporal onset of the deficits was classified by consensus as either an "early stroke," which is present just after emergence from anesthesia, or a "delayed stroke," which is present after first awaking from surgery without a neurologic deficit.
Results:
More than half of strokes (29 of 46; 63%) were delayed strokes. Patients undergoing off-pump CABG had significantly lower risk of early stroke (0.1% versus 1.1%, p = 0.0009), whereas the incidence of delayed strokes was not different significantly (0.9% versus 1.4%, p = 0.3484) between patients undergoing on-pump and off-pump CABG. In multivariate analyses, undergoing off-pump CABG was an independent protective factor for all strokes (relative risk 0.29, 95% confidence interval: 0.14 to 0.56, p = 0.0005) and early strokes (relative risk 0.05, 95% confidence interval: 0.003 to 0.24, p < 0.0001), but it was not an independent protective factor for delayed strokes (relative risk 0.54, 95% confidence interval: 0.24 to 1.17, p = 0.1210).
Conclusions:
Undergoing off-pump CABG reduces the incidence of perioperative stroke mainly by minimizing early strokes; however, the risk of delayed strokes is not different between patients undergoing on-pump and off-pump CABG.
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