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Risk factors for stroke after cardiac surgery: Buffalo Cardiac-Cerebral Study Group
J J Ricotta1, G L Faggioli, A Castilone
1Department of Surgery, State University of New York at Buffalo.
Insights
Identifying stroke risk factors in heart surgery patients is crucial. Key risks include carotid artery stenosis over 50%, redo surgery, valve surgery, and prior stroke, guiding pre-operative patient selection.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Risk Factor Analysis
Background:
- Stroke is a significant complication following cardiac surgery.
- Identifying pre-operative risk factors can improve patient outcomes and surgical planning.
Purpose of the Study:
- To identify pre-operative risk factors associated with stroke in patients undergoing heart surgery.
- To analyze the relationship between specific patient characteristics and the incidence of stroke post-cardiac procedures.
Main Methods:
- Retrospective chart review of 1,179 patients undergoing cardiac surgery across three hospitals.
- Data collection included demographics, risk factors, and post-operative stroke and mortality outcomes.
- Carotid artery stenosis was assessed using duplex examination; statistical analysis employed chi-squared and logistic regression.
Main Results:
- The overall stroke rate was 1.6%, with a mortality rate of 2.3%.
- Significant stroke risk factors identified: carotid artery stenosis >50%, redo heart surgery, valve surgery, and prior stroke.
- Carotid artery stenosis >50% was present in 14.7% of cases; strokes often occurred >24 hours post-surgery.
Conclusions:
- A subset of patients at high risk for neurologic events after heart surgery can be identified pre-operatively.
- Carotid artery stenosis >50% is a strong predictor, but the benefit of prophylactic endarterectomy requires further investigation.
- Future research should focus on this high-risk subgroup, potentially through prospective studies on prophylactic carotid endarterectomy.
Purpose:
The purpose of this study was to identify risk factors for stroke in patients undergoing heart surgery.
Methods:
A retrospective chart review of patients who underwent cardiac surgery in three hospitals of the State University of New York at Buffalo system over a 36-month period was completed. Demographics and risk factors were recorded, and stroke and death were determined by chart review. Carotid artery stenosis was determined by duplex examination. Data were analyzed by chi-squared and multiple logistic regression.
Results:
One thousand one hundred seventy-nine cases were analyzed, with a mortality rate of 2.3%, stroke rate of 1.6%, and combined stroke/death rate of 3.1%. Four variables were found to be associated with an increased risk of stroke: carotid artery stenosis greater than 50%, redo heart surgery, valve surgery, and prior stroke. Five variables were associated with increased mortality rates:; carotid artery stenosis greater than 50%, redo surgery, peripheral vascular disease, longer pump time, and hypercholesterolemia. Carotid artery stenosis greater than 50% was present in 14.7% of cases. Carotid artery stenosis greater than 75% was not itself associated with increased stroke risk. Most strokes occurred more than 24 hours after surgery. Stroke distribution did not correlate with site of carotid artery stenosis greater than 50%.
Conclusions:
Most neurologic events after heart surgery occur in a subset of patients who can be defined before operation. Whereas carotid artery stenosis greater than 50% is a strong risk factor, the role of prophylactic endarterectomy is unclear. Future studies should focus on this high-risk subgroup. A prospective study of prophylactic carotid endarterectomy in patients undergoing coronary artery bypass grafting is needed.