Risk Score Elaboration for Stroke in Cardiac Surgery

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.