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Major stroke after coronary artery bypass surgery: changing magnitude of the problem
Insights
The number of patients undergoing coronary artery bypass grafting (CABG) increased, with older patients experiencing lower mortality but higher stroke risk. Age is a significant factor in stroke development post-CABG.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Clinical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- Patient demographics and outcomes for CABG have evolved over time.
- Understanding trends in CABG patient populations and associated risks is crucial.
Purpose of the Study:
- To analyze trends in patient age, operative mortality, and stroke incidence over an 11-year period for isolated CABG.
- To investigate the correlation between increasing patient age and the risk of stroke after CABG.
- To identify risk factors for stroke in CABG patients.
Main Methods:
- Retrospective analysis of 3816 isolated CABG cases performed between January 1974 and December 1984.
- Statistical analysis of annual patient numbers, mean patient age, operative mortality rates, and stroke incidence.
- Correlation analysis to assess the relationship between patient age and stroke risk.
Main Results:
- A significant increase in the annual number of CABG operations and the mean patient age was observed.
- Operative mortality significantly decreased from 3.9% in 1974 to 2.0% in 1984.
- The overall stroke incidence was 1.8%, with a rise to 2.4% between 1982-1984, significantly associated with older patient age.
Conclusions:
- Despite declining mortality, the incidence of stroke after CABG increased, particularly in older patients.
- Patients in their 70s had a fivefold greater stroke risk compared to those aged 51-60.
- Age is a critical independent risk factor for stroke following CABG, necessitating further investigation into specific risk factors.
Abstract:
Between January 1974 and December 1984, 3816 patients underwent isolated CABG at this hospital. During this 11-year interval, the number of patients having operation annually as well as the mean age at operation of the patients have increased significantly. The increase in the mean age from 51.9 years in 1974 to 59.4 years in 1984 occurred while the operative mortality rate fell significantly from 3.9% in 1974 to 2.0% in 1984. Although the overall incidence of major stroke was 1.8%, the stroke rate increased during this interval to 2.4% from 1982 to 1984. This higher stroke rate correlates significantly with the increasing age of the CABG patients, with the stroke risk five times greater for patients in their 70s compared with patients between 51 and 60 years old. Specific risk factors for the development of stroke during CABG in addition to age were examined and discussed.