Related Experiment Video
Updated: Jun 10, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Impact of Covert Brain Infarction Following Coronary Angiography on Coronary Artery Bypass Surgery Outcomes
Hyun-Uk Kang1, Ji-Hoon Sim1, Jae-Sik Nam1
1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Preoperative covert brain infarction after coronary angiography (CAG) does not increase major adverse cardiac and cerebrovascular events (MACCEs) or long-term mortality following coronary artery bypass grafting (CABG). This finding suggests CAG-related brain changes may not impact CABG outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Radiology
Background:
- Coronary angiography (CAG) is a common procedure preceding coronary artery bypass grafting (CABG).
- Covert cerebral infarction, detected via brain magnetic resonance imaging (MRI), can occur post-CAG.
- The clinical significance of these subclinical infarcts on subsequent cardiac surgery outcomes remains unclear.
Purpose of the Study:
- To investigate the association between preoperative covert brain infarction detected by MRI after CAG and major adverse cardiac and cerebrovascular events (MACCEs) following elective CABG.
- To evaluate the impact of these infarcts on short-term (30-day) and long-term (5-year) outcomes, including all-cause mortality.
Main Methods:
- A cohort study included patients undergoing preoperative CAG and brain MRI before elective CABG at a single tertiary center.
- Propensity-score matching was used to compare outcomes between patients with and without covert cerebral infarction.
- Primary outcome: MACCEs within 30 days of CABG. Secondary outcomes: individual MACCE components and 5-year all-cause mortality.
Main Results:
- Of 2,476 patients, 8.6% had preoperative covert cerebral infarction.
- After propensity-score matching (n=1,057), the 30-day MACCE incidence was similar: 15.1% in the infarction group vs. 15.6% in the control group (p=0.85).
- No significant differences were observed in MACCE components or 5-year all-cause mortality between the groups.
Conclusions:
- Preoperative covert brain infarction following CAG is not significantly associated with an increased risk of 30-day MACCEs after CABG.
- These findings suggest that CAG-induced subclinical brain injury does not adversely affect short-term or long-term outcomes following elective CABG.
- Further research may explore specific patient subgroups or alternative cerebrovascular monitoring strategies.
Objective:
To determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass grafting (CABG).
Design:
A cohort study was conducted between January 2006 and December 2019, with the follow-up period concluding at either 5 years after surgery, the date of death, or April 27, 2023.
Setting:
A single tertiary center in Korea.
Participants:
Patients who underwent preoperative CAG and subsequent brain magnetic resonance imaging (MRI) before elective CABG.
Interventions:
None.
Measurements And Main Results:
The primary outcome was the incidence of MACCEs within 30 days of CABG. MACCEs included operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. Secondary outcomes included each component of MACCEs and all-cause mortality at 5 years after surgery. Of the 2,476 study patients (median [interquartile range] age: 65 [58-71] years; 24.7% were female), 212 (8.6%) had covert cerebral infarction on brain MRI after CAG but before CABG, and 353 (14.3%) patients experienced MACCEs after CABG. After performing 1:4 propensity-score matching, 1,057 patients were included in the final outcome analysis (212 with covert brain infarction and 845 without). The incidence of MACCEs within 30 days was not significantly different between patients with covert brain infarction and those without (15.1% [32/212] v 15.6% [132/845]; risk difference: -0.5, 95% confidence interval: -5.6 to 4.4; risk ratio: 0.97, 95% confidence interval: 0.66 to 1.32, p = 0.85). There were also no significant differences in each component of MACCEs within 30 days. There was no significant difference between the two groups regarding all-cause mortality at 5 years (18.7% v 17.0%, respectively, p for stratified log-rank test = 0.33).
Conclusions:
Among patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCEs within 30 days or long-term mortality after CABG.
