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Risk factors of stroke and delirium after off-pump coronary artery bypass surgery

Shinichiro Miyazaki1, Kenji Yoshitani, Norikazu Miura

  • 1Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.

Interactive Cardiovascular and Thoracic Surgery
|December 15, 2010
PubMed

Insights

Advanced arteriosclerosis, particularly carotid artery stenosis over 50%, significantly increases stroke, TIA, and delirium risk after off-pump CABG. Other factors like AF and diabetes also elevate stroke risk.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Medicine

Background:

  • Off-pump coronary artery bypass grafting (CABG) aims to reduce surgical risks.
  • However, postoperative stroke and delirium remain concerns.
  • Advanced arteriosclerosis is prevalent in CABG patients.

Purpose of the Study:

  • To investigate if advanced arteriosclerotic changes are risk factors for stroke, transient ischemic attack (TIA), and delirium following off-pump CABG.
  • To identify specific predictors of these adverse postoperative outcomes.

Main Methods:

  • Retrospective review of 685 patients undergoing off-pump CABG (2001-2005).
  • Analysis of medical records and carotid artery duplex scan data for arteriosclerosis indices.
  • Statistical examination of potential risk factors for stroke/TIA and delirium.

Main Results:

  • Postoperative stroke/TIA incidence was 2.6%; delirium incidence was 16.4%.
  • Carotid artery stenosis >50% was a significant risk factor for both stroke/TIA (P=0.02) and delirium (P=0.04).
  • History of atrial fibrillation (AF) or diabetes mellitus predicted stroke/TIA; advanced age, elevated creatinine, hypertension, prior AF, and smoking predicted delirium.

Conclusions:

  • Advanced arteriosclerosis, especially significant carotid stenosis, is a key risk factor for stroke, TIA, and delirium after off-pump CABG.
  • Preoperative identification of these risk factors can aid in patient management and risk stratification.

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