Postoperative stroke in CABG: a ten-year study of stroke incidence and contributing risk factors in Jordan
Emad Hijazi1,2, Nabil Al-Zoubi1,2, Qusai Aljarrah1,2
1Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Insights
Stroke after coronary artery bypass grafting (CABG) is a risk, especially for women. This study found a 1.12% stroke rate in Jordanian patients, highlighting the need for improved surgical techniques.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Public Health
Background:
- Stroke is a significant complication following coronary artery bypass grafting (CABG), affecting approximately 3% of patients.
- Neurologic dysfunction is a known challenge in cardiac surgery, particularly with cardiopulmonary bypass.
- Limited data exists on stroke rates in specific populations, such as those in low-volume centers in developing countries.
Purpose of the Study:
- To determine the incidence of stroke after elective coronary artery bypass grafting (CABG) in a Jordanian population.
- To analyze stroke risk factors in patients undergoing CABG at a low-volume cardiac center.
- To identify potential strategies for reducing postoperative stroke in similar settings.
Main Methods:
- An observational descriptive study was conducted involving 446 patients who underwent CABG between January 2011 and December 2021.
- Data on patient demographics, medical history, and postoperative outcomes, specifically stroke occurrence, were collected and analyzed.
- Incidence rates were calculated and compared between genders and across different risk factor profiles.
Main Results:
- A total of five patients (1.12%) experienced a stroke post-CABG.
- The stroke incidence was higher in female patients (1.9%) compared to male patients (0.4%).
- Among female patients who had a stroke, 75% had diabetes mellitus and 50% had a history of transient ischemic attacks (TIAs).
Conclusions:
- The stroke rate following CABG in this Jordanian cohort was 1.12%, lower than the reported 3% in some literature.
- Female patients, particularly those with diabetes and a history of TIAs, exhibited a higher risk of stroke post-CABG.
- Minimizing aortic manipulation during CABG, especially in patients with cerebrovascular risk factors, may help reduce postoperative stroke incidence in resource-limited settings.
Abstract:
Stroke is a serious complication that occurs in approximately 3% of patients undergoing elective coronary artery bypass grafting (CABG). Neurologic dysfunction is a well-researched challenge in cardiac surgery, particularly when cardiopulmonary bypass is used. This study aimed to determine the stroke rate following CABG in a Jordanian population, based on our experience at a low-volume cardiac center. We conducted an observational descriptive study involving 446 patients who underwent CABG between January 2011 and December 2021. Stroke occurred in five patients (1.12%). Among 208 female patients, four developed stroke (1.9%), three of whom had diabetes mellitus (75%), and two had a prior history of transient ischemic attacks (TIAs). In contrast, only one out of 238 male patients experienced a stroke (0.4%); this patient had diabetes but had no history of TIA. The incidence of stroke in female patients was four times higher than in men. These findings suggest that improving surgical techniques, particularly in low-resource or developing settings, may contribute to reducing the risk of postoperative stroke. Strategies such as minimizing aortic manipulation during CABG while utilizing cardiopulmonary bypass could be beneficial, especially in patients with known risk factors for cerebrovascular events.
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