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Updated: Oct 29, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Risk Score Elaboration for Stroke in Cardiac Surgery
Ellen Hettwer Magedanz1, João Carlos Vieira da Costa Guaragna1, Luciano Cabral Albuquerque1
1Cardiology Service, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Insights
A new risk score helps predict stroke after heart surgery. This tool identifies patients at low, medium, high, or very high risk, aiding in better patient management and outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Informatics
Background:
- Stroke is a significant complication following heart surgery, associated with high morbidity and mortality rates.
- Existing risk assessment models often lack evaluation of postoperative morbidity.
- There is a need for a validated tool to predict stroke risk specifically in the context of heart surgery with cardiopulmonary bypass.
Purpose of the Study:
- To develop and validate a risk score for predicting postoperative stroke in patients undergoing heart surgery with cardiopulmonary bypass.
- To identify key independent predictors of stroke in this patient population.
Main Methods:
- A cohort study utilizing data from 4,862 patients who underwent heart surgery between 1996 and 2016.
- Logistic regression analysis to identify independent predictors of stroke.
- Model construction using data from 3,258 patients and validation on 1,604 patients, assessed by the area under the receiver operating characteristic (ROC) curve.
Main Results:
- The postoperative stroke prevalence was 3% (149 patients), with a 31.5% mortality rate among affected patients.
- Independent predictors of stroke included advanced age, urgent/emergency surgery, peripheral arterial occlusive disease, history of cerebrovascular disease, and cardiopulmonary bypass time ≥ 110 minutes.
- The developed risk score demonstrated an area under the ROC curve of 0.71 (95% CI 0.66–0.75).
Conclusions:
- A novel risk score for predicting stroke after heart surgery has been successfully developed and validated.
- This score effectively categorizes patients into low, medium, high, or very high-risk groups for surgery-related stroke.
- The tool can aid clinicians in assessing and managing the risk of stroke in patients undergoing heart surgery.
Introduction:
Stroke is a complication that causes considerable morbidity and mortality during the heart surgery postoperative period (incidence: 1.3 to 5%; mortality: 13 to 41%). Models for assessing the risk of stroke after heart surgery have been proposed, but most of them do not evaluate postoperative morbidity. The aim of this study was to develop a risk score for postoperative stroke in patients who undergo heart surgery with cardiopulmonary bypass.
Methods:
A cohort study was conducted with data from 4,862 patients who underwent surgery from 1996 to 2016. Logistic regression was used to assess relationships between risk factors and stroke. Data from 3,258 patients were used to construct the model. The model's performance was then validated using data from the remainder of the patients (n=1,604). The model's accuracy was tested using the area under the receiver operating characteristic (ROC) curve.
Results:
The prevalence of stroke during the postoperative period was 3% (n=149); 59% of the patients who exhibited this outcome were male, 51% were aged ≥ 66 years, and 31.5% of the patients died. The variables that remained as independent predictors of the outcome after multivariate analysis were advanced age, urgent/emergency surgery, peripheral arterial occlusive disease, history of cerebrovascular disease, and cardiopulmonary bypass time ≥ 110 minutes. The area under the ROC curve was 0.71 (95% confidence interval 0.66 - 0.75).
Conclusion:
We were able to develop a risk score for stroke after heart surgery. This score classifies patients as low, medium, high, or very high risk of a surgery-related stroke.
