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Published on: March 27, 2018
Factors associated with long-term survival in patients with stroke after coronary artery bypass grafting
Brandie D Wagner1,2, Gary K Grunwald1,2, G Hossein Almassi3
1Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.
Insights
Patients experiencing stroke after coronary artery bypass grafting (CABG) face significantly higher mortality, especially within the first year. Identifying risk factors is crucial for improving long-term survival post-stroke after CABG.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Outcomes Research
Background:
- Stroke is a rare but severe complication following coronary artery bypass grafting (CABG).
- Understanding long-term survival factors for these patients is critical for clinical management.
Purpose of the Study:
- To identify factors associated with long-term survival (beyond 30 days) in patients who experience stroke after CABG.
- To analyze risk factors and perioperative complications impacting survival in post-CABG stroke patients.
Main Methods:
- Utilized de-identified patient records from the Veterans Affairs Surgical Quality Improvement Program database.
- Employed a multivariable Cox proportional hazards model to analyze survival up to 20 years.
- Identified risk factors and perioperative complications associated with survival.
Main Results:
- Median survival for patients with post-CABG stroke was 6.7 years.
- Mortality was highest in the first year post-CABG, with significantly elevated rates compared to non-stroke patients.
- Key predictors of 1-year mortality included high preoperative creatinine, postoperative renal failure, prolonged ventilation, coma, and reoperation for bleeding.
Conclusions:
- Veterans with post-CABG stroke exhibit a substantially increased risk of mortality within the first year.
- These findings highlight the critical need for vigilant monitoring and management of post-CABG stroke patients.
Objective:
Occurrence of a stroke within 30 days following coronary artery bypass grafting (CABG) is an uncommon, but often devastating, complication. This study aimed to identify factors associated with long-term survival (beyond 30 days) in patients with stroke after CABG.
Methods:
De-identified patients' records from the Veterans Affairs Surgical Quality Improvement Program database were used to identify risk factors and perioperative complications associated with survival for up to 20 years in patients with post-CABG stroke. The multivariable Cox proportional hazards model was used for analyzing survival.
Results:
The median survival time for patients with stroke (n = 1422) was 6.7 years. The mortality rate for these patients was highest in the first year post-CABG and was significantly elevated compared with non-stroke patients. Survival rates at 1, 5, and 10 years for stroke versus non-stroke patients were 79% vs. 96%, 58% vs. 83%, and 36% vs. 63%, respectively. High preoperative serum creatinine levels, postoperative occurrence of renal failure, prolonged ventilation, coma, and reoperation for bleeding were important predictors of 1-year mortality of patients with post-CABG stroke.
Conclusions:
Veterans with post-CABG stroke have a considerably higher risk for mortality during the first year compared with patients without stroke.
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