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Published on: November 28, 2018
Risk Factors Associated with Ischemic Stroke in the Immediate Postoperative Period of Cardiac Surgery
Luana Quintana Marchesan1, Marco Aurélio Lumertz Saffi2, Leticia Fioravante da Silveira3
1Postgraduate Program in Health Science, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
Insights
Identifying stroke risk factors after cardiac surgery is crucial. Previous stroke, carotid disease, atrial fibrillation, and high postoperative platelets increase stroke risk, aiding clinical prediction models.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Epidemiology
Background:
- Stroke is a significant complication following cardiac surgery, with an incidence as high as 6%.
- Identifying modifiable and non-modifiable risk factors is essential for patient management.
Purpose of the Study:
- To investigate risk factors for ischemic stroke in patients undergoing contemporary cardiac surgery.
- To develop a predictive model for postoperative stroke.
Main Methods:
- Retrospective cohort study of 678 adult patients undergoing cardiac surgery with cardiopulmonary bypass.
- Poisson regression analysis with robust variance was used to develop a predictive model.
Main Results:
- The early stroke rate was 3.5% (24 patients), with 3.3% being ischemic.
- Significant stroke predictors included prior stroke/transient ischemic attack (RR=2.75), carotid artery disease (RR=4.0), previous atrial fibrillation (RR=3.26), and postoperative platelets > 200,000/mm³ (RR=2.26).
Conclusions:
- A contemporary predictive model for stroke after cardiac surgery was developed.
- This model can assist clinicians in identifying high-risk patients for targeted interventions.
Introduction:
Stroke remains a major complication of cardiac surgery. Despite all efforts, the incidence of postoperative stroke remains as high as 6%. We aimed to investigate risk factors for ischemic stroke in a contemporary cohort of patients undergoing cardiac surgery.
Methods:
This is a retrospective cohort study of 678 consecutive adult patients who underwent cardiac surgery requiring cardiopulmonary bypass in a tertiary hospital in Brazil between July 1, 2011, and December 31, 2018. The primary outcome was the rate of early (perioperative and seven-day postoperative) stroke, defined as the occurrence of the outcome during the index admission. We developed a predictive model of stroke using the Poisson regression analysis with robust variance.
Results:
Postoperative stroke occurred in 24 patients (3.5%), 23 (3.3%) were ischemic, and 21 (3.0%) were diagnosed in the first 72 hours after surgical procedure. After multivariate analysis, the following factors were significantly associated with stroke: previous stroke/transient ischemic attack (relative risk [RR]=2.75; 95% confidence interval [CI], 1.11-6.82), carotid artery disease (RR=4.0; 95% CI, 1.43-11.0), previous atrial fibrillation (RR=3.26, 95% CI, 1.31-8.1), and postoperative platelets > 200,000/mm3 (RR=2.26; 95% CI, 1.01-5.1).
Conclusion:
We developed a contemporary model to determine risk predictors for stroke after cardiac surgery. This model may help clinicians to identify patients at risk and could be useful in clinical practice.
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