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Published on: March 27, 2018
Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery
Sultana Habib1, Arif ur Rehman Khan2, M Iqbal Afridi3
1Department of Adult Cardiology , National Institute of Cardiovascular Disease (NICVD), Karachi.
Insights
Cognitive impairment is common after first-time coronary artery bypass graft surgery (CABGS), persisting short-term. Older age, female gender, and elevated postoperative creatinine predict cognitive decline in CABGS patients.
Area of Science:
- Cardiology
- Neurology
- Psychiatry
Background:
- Coronary artery bypass graft surgery (CABGS) is a common procedure for cardiovascular disease.
- Cognitive impairment is a potential complication following major surgeries, including CABGS.
- Understanding the prevalence and predictors of cognitive decline is crucial for patient management.
Purpose of the Study:
- To determine the frequency of cognitive impairment in patients undergoing their first-time CABGS.
- To identify predictors associated with cognitive decline in this patient population.
Main Methods:
- An observational study conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi.
- Included patients over 18 undergoing elective first-time CABGS, excluding emergency cases or those with recent myocardial infarction or psychiatric illness.
- Cognitive function was assessed using McNair's and MMSE scales pre-surgery, at discharge, 6 weeks, and 6 months post-CABG. HDRS was used to assess depression.
Main Results:
- A total of 134 patients were followed. Baseline cognitive disturbance was 44.8%, rising to 54.5% at discharge, with improvement to 39.7% at 6 months.
- Prevalence of cognitive disturbance increased post-CABGS, with significant short-term persistence.
- Older age, female gender, increased bleeding episodes, and high postoperative creatinine levels were associated with cognitive decline.
Conclusions:
- Postoperative cognitive deficit is a common and short-term persistent issue following CABGS.
- Key predictors for cognitive decline include older age, female gender, and elevated postoperative creatinine.
- A high frequency of acute depression was observed pre-surgery, which significantly reduced over time.
Objective:
To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS).
Study Design:
An observational study.
Place And Duration Of Study:
The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009.
Methodology:
Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline.
Results:
One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline.
Conclusion:
Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.
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