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Neurological injury in patients with acute myocardial infarction undergoing operative myocardial revascularization
Frederik Heumüller1, Katharina Huenges1, Nourane Trigui2
1Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Campus Kiel Arnold-Heller Strasse 3, Haus C, 24105, Kiel, Germany.
Insights
Patients undergoing coronary artery bypass graft (CABG) surgery after acute myocardial infarction (AMI) face a higher risk of neurological events (NE). Smokers and those needing cardiopulmonary resuscitation (CPR) pre-operatively are particularly vulnerable, impacting long-term survival.
Area of Science:
- Cardiology
- Neurology
- Cardiac Surgery
Background:
- Acute myocardial infarction (AMI) increases the risk of neurological events (NE).
- Patients undergoing coronary artery bypass graft (CABG) surgery post-AMI may have a heightened risk of peri-operative NE.
- Limited data exists on the specific risks and outcomes for AMI patients undergoing urgent CABG.
Purpose of the Study:
- To analyze the incidence and outcomes of peri-operative neurological events (NE) in patients undergoing coronary artery bypass graft (CABG) surgery within 48 hours of acute myocardial infarction (AMI).
- To identify risk factors and predictors of mortality in this high-risk patient group.
Main Methods:
- Retrospective analysis of 1628 patients undergoing CABG within 48 hours of AMI diagnosis.
- Comparison of outcomes between patients with and without peri-operative NE.
- Primary outcomes: 30-day mortality and long-term survival.
- Secondary outcomes: ICU length of stay, transfusion rates, and need for renal replacement therapy (RRT).
Main Results:
- 4.7% of patients experienced peri-operative NE (4.0% thromb-embolic strokes, 0.7% hypoxic brain damage).
- NE patients were more likely to be smokers, have reduced left ventricular function, and require pre-operative CPR (p<0.001).
- NE patients had higher 30-day mortality (20.8% vs 10.7%) and significantly impaired 10-year survival (39% vs 69%).
- Peripheral artery disease and need for CPR were independent predictors of 30-day mortality in NE patients.
Conclusions:
- AMI patients undergoing urgent CABG are at increased risk for neurological injuries.
- Patients with generalized atherosclerosis and those requiring pre-operative CPR represent a vulnerable subgroup.
- Further research is needed to explore interventions that may reduce stroke rates in this population.
Background:
Acute myocardial infarction (AMI) is associated with an increased rate of neurological events (NE). AMI patients, who undergo coronary artery bypass graft (CABG) surgery may be at an even greater risk for peri-operative NE, but detailed data is missing.
Methods:
We conducted a retrospective, single-center data analysis of 1628 patients that underwent CABG within 48 h after being diagnosed with AMI. Between 01/2001 and 03/2023, 77 patients (4.7%) suffered from a peri-operative NE. This included 66 (4.0%) thromb-embolic strokes and 11 (0.7%) hypoxic brain damages. We compared the outcome between NE patients and those without (w/o) NE. Primary outcome parameters were 30-day mortality and long-term survival. Secondary outcome parameters included post-operative ICU length of stay, transfusion rates and need for renal replacement therapy (RRT).
Results:
Median time from AMI diagnosis to CABG was 7.6 h (4.4-16.4 h). Significantly more NE patients were smokers (n = 36(46.8%) vs. n = 532(34.5%);p = 0.04) and presented with a severely reduced left ventricular function pre-operatively (n = 15(20.3%) vs. n = 161(11.1%);p = 0.02). NE patients had undergone CPR pre-operatively more often than patients w/o NE (n = 23(29.9%)vs n = 168(10.8%);p < 0.001). Accordingly, EuroScore II was significantly higher in NE patients compared to patients w/o NE (7.8 (4.2-14.3) vs. 4.9 (2.8-10.2); p < 0.001). Intra-operatively, bypass-time proved to be longer in NE patients (117 (94-149) vs. 107 (88-130)minutes; p = 0.02). Post-operatively, significantly more NE patients had to stay longer than 48 h in the ICU (n = 72 (94.7%) vs. n = 866 (55.8%); p < 0.001). Neither transfusion rates nor need for RRT differed between the groups. Thirty day mortality was higher in NE patients (n = 16 (20.8%) vs. n = 165 (10.7%); p < 0.01). Pre-operative diagnosis of peripheral artery disease (pad) and need for CPR were identified as independent predictors of 30-day mortality in NE patients. Ten-year survival of NE patients remained impaired compared to patients w/o NE (39% vs. 69%; p < 0.001).
Conclusion:
AMI Patients undergoing CABG within 48 h are at an increased risk for neurological injuries. In particular, patients with generalized atherosclerosis and those that underwent CPR pre-operatively, seem to represent a vulnerable subgroup. Further studies have to clarify whether individualized peri-operative actions may reduce the stroke rates in this setting.
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