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Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits
G L Reed1, D E Singer, E H Picard
1Department of Medicine, Massachusetts General Hospital, Boston 02114.
Insights
Carotid bruits, abnormal sounds in neck arteries, significantly increase stroke risk after coronary artery bypass surgery. This finding aids in identifying patients needing closer monitoring post-procedure.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Medicine
Background:
- Stroke is a known complication of coronary artery bypass surgery (CABG).
- The specific causes and risk factors for postoperative stroke remain incompletely understood.
- Identifying modifiable or detectable risk factors is crucial for patient management.
Purpose of the Study:
- To investigate whether the presence of carotid bruits, indicative of carotid artery narrowing, is associated with an increased risk of stroke or transient ischemic attacks (TIAs) after CABG.
- To identify other significant risk factors for neurological complications following CABG.
Main Methods:
- A case-control study was conducted on 5915 patients undergoing CABG between 1970 and 1984.
- 54 patients who experienced postoperative stroke or TIAs were compared with 54 randomly selected control patients.
- Preoperative carotid bruits and other clinical variables were analyzed using case-control and multiple logistic regression analyses.
Main Results:
- The presence of preoperative carotid bruits was associated with a 3.9-fold increased risk of stroke or TIAs after CABG.
- Other significant risk factors included a history of stroke/TIA, congestive heart failure, mitral regurgitation, postoperative atrial fibrillation, prolonged cardiopulmonary bypass time (>2 hours), and prior myocardial infarction.
- The absolute risk of stroke associated with carotid bruits was 2.9%.
Conclusions:
- Carotid bruits are a significant risk factor for stroke following coronary artery bypass surgery.
- While the risk is elevated, the absolute magnitude is small and comparable to risks associated with carotid endarterectomy.
- These findings suggest that preoperative screening for carotid bruits may help identify patients at higher risk for neurological complications after CABG.
Abstract:
The causes of stroke following coronary-artery bypass surgery are largely unknown. To determine whether carotid bruits increase the risk of these events, we compared 54 patients with postoperative stroke or transient ischemic attacks with 54 randomly selected control patients. Both groups were drawn from 5915 consecutive patients who had coronary bypass surgery at our hospital from 1970 to 1984. Carotid bruits were noted preoperatively in 13 patients with postoperative stroke and in 4 control patients. Case-control analysis showed that the presence of carotid bruits increased the risk of stroke or transient ischemic attacks by 3.9-fold (95 percent confidence interval, 1.2 to 12.8; P less than 0.05). This increased risk remained essentially unchanged after adjustment for potentially confounding variables in a multiple logistic regression analysis. Other factors associated with a significantly increased risk (P less than 0.05) of these neurologic deficits were a history of stroke or transient ischemic attack (odds ratio, 6.0; 95 percent confidence interval, 1.6 to 22.1), a history of congestive heart failure (odds ratio, 5.3; confidence interval, 1.6 to 17.0), mitral regurgitation (odds ratio, 4.3; confidence interval, 1.4 to 12.9), postoperative atrial fibrillation (odds ratio, 3.0; confidence interval, 1.4 to 6.7), a cardiopulmonary-bypass pump time of more than two hours (odds ratio, 2.7; confidence interval, 1.1 to 6.7), and a previous myocardial infarction (odds ratio, 2.3; confidence interval, 1.1 to 5.1). We conclude that the presence of carotid bruits increases the risk of stroke after coronary-artery bypass surgery. However, the absolute magnitude of this risk, 2.9 percent, is small and comparable to the reported risk of stroke from carotid endarterectomy.
