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Consequence of Ischemic Stroke after Coronary Surgery with Cardiopulmonary Bypass According to Stroke Subtypes
Mustafa Aldag1, Cemal Kocaaslan1, Mehmet Senel Bademci1
1Department of Cardiovascular Surgery, Istanbul Medeniyet University Medical Faculty, Istanbul, Turkey.
Insights
Outcomes for ischemic stroke after coronary artery bypass grafting (CABG) varied by stroke type. Total anterior circulation infarction (TACI) showed significantly higher mortality and disability than lacunar infarction (LACI).
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Coronary artery bypass grafting (CABG) is a common procedure, but carries risks including postoperative stroke.
- Ischemic stroke following CABG can lead to significant morbidity and mortality.
- Understanding stroke subtypes and their impact is crucial for patient management.
Purpose of the Study:
- To determine the outcomes of patients who develop ischemic stroke after undergoing coronary artery bypass grafting (CABG).
- To analyze mortality rates, survival, and disability based on stroke classification.
- To evaluate the utility of the Oxfordshire Community Stroke Project (OCSP) classification and modified Rankin Scale (mRS) in predicting outcomes.
Main Methods:
- Retrospective analysis of 5380 patients undergoing elective coronary surgery from March 2012 to January 2017.
- Inclusion of 95 patients who developed ischemic stroke post-on-pump CABG.
- Classification of strokes into TACI, PACI, POCI, and LACI using the OCSP system; assessment of outcomes using mRS.
Main Results:
- The incidence of stroke was 1.76%. The majority of strokes were partial anterior circulation infarction (PACI, 49.5%).
- In-hospital mortality was 29.5%, and cumulative mortality reached 35.8%.
- Total anterior circulation infarction (TACI) group exhibited significantly higher in-hospital and cumulative mortality rates and higher mRS scores compared to other groups.
Conclusions:
- Patients experiencing TACI after CABG face considerably worse outcomes, including higher mortality and greater disability.
- The OCSP classification and mRS are valuable tools for predicting stroke outcomes in patients post-coronary surgery.
- Further research may refine risk stratification and management strategies for these high-risk patients.
Introduction:
The aim of this study was to determine the outcomes of patients developing ischemic stroke after coronary artery bypass grafting (CABG).
Methods:
From March 2012 to January 2017, 5380 consecutive patients undergoing elective coronary surgery were analyzed. Ninety-five patients who developed ischemic strokes after on-pump coronary surgery were included in the study, retrospectively. The cohort was divided into four subgroups [total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), and lacunar infarction (LACI)] according to the Oxfordshire Community Stroke Project (OCSP) classification. The primary endpoints were in-hospital mortality, total mortality, and survival analysis over an average of 30 months of follow-up. The secondary endpoints were the extent of disability and dependency according to modified Rankin Scale (mRS).
Results:
The incidence of stroke was 1.76% (n=95). The median age was 62.03±10.06 years and 68 (71.6%) patients were male. The groups were as follows: TACI (n=17, 17.9%), PACI (n=47, 49.5%), POCI (n=20, 21.1%), and LACI (n=11, 11.6%). Twenty-eight (29.5%) patients died in hospital and 34 (35.8%) deaths occurred. The overall mortality rate of the TACI group was significantly higher than that of the LACI group (64.7% vs. 27.3%, P=0.041). The mean mRS score of the TACI group was significantly higher than that of the other groups (P=0.003).
Conclusion:
Patients in the TACI group had higher in-hospital and cumulative mortality rates and higher mRS scores. We believe that use of the OCSP classification and the mRS may render it possible to predict the outcomes of stroke after coronary surgery.
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