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Multicenter preoperative stroke risk index for patients undergoing coronary artery bypass graft surgery. Multicenter
M F Newman1, R Wolman, M Kanchuger
1Department of Anesthesiology, Duke Heart Center, Durham, NC, USA. Newma005@mc.duke.edu
Insights
This study developed a preoperative stroke risk index for coronary artery bypass graft surgery patients. The McSPI index helps estimate neurological risk and identify optimal perioperative therapy groups.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Informatics
Background:
- Elderly and debilitated patients benefit most from cardiac surgery but face higher risks.
- Predicting perioperative neurological events is crucial for patient management.
Purpose of the Study:
- To develop a preoperative index for predicting major perioperative neurological events in patients undergoing coronary artery bypass graft (CABG) surgery.
Main Methods:
- Prospective, multicenter, observational study of 2107 patients undergoing CABG.
- Identified key preoperative predictors including age, neurological disease history, diabetes, vascular disease history, prior CABG, unstable angina, and pulmonary disease.
- Developed and validated a stroke risk index using principal components analysis and bootstrap validation (c-index = 0.778).
Main Results:
- 68 patients (3.2%) experienced adverse neurological events (stroke, TIA, coma).
- The McSPI stroke risk index effectively predicted neurological events.
- Calculated patient-specific stroke risk within 95% confidence intervals.
Conclusions:
- The McSPI stroke risk index enables neurological risk estimation in CABG patients.
- Facilitates identification of appropriate patient groups for perioperative therapy.
- Further refinement and validation of the index are ongoing.
Background:
The paradox of present cardiac surgery is that the more elderly and debilitated patients benefit most from cardiac surgery compared with medical therapy, yet they sustain greater overall risk for morbidity and mortality after cardiac surgery. The goal of the present study was to develop a preoperative index predicting major perioperative neurological events in patients undergoing coronary artery bypass graft surgery.
Methods And Results:
As part of a prospective, multicenter, observational study (McSPI Research Group), we enrolled 2417 patients at 24 academic medical centers in the United States. Patients who died intraoperatively or had concomitant open-heart procedures were excluded from analysis, resulting in a total of 2107 for analysis. Sixty-eight patients (3.2%) developed adverse neurological events, defined as cerebrovascular accident, transient ischemic attack (TIA), or persistent coma. Bivariate analysis was applied to determine associations between preoperative variables and neurological events. Significant bivariate predictors were identified then logically grouped, and for each cluster, a score was calculated based on principal components. Key predictor variables were age, history of previous neurological disease, diabetes, history of vascular disease, previous coronary artery surgery, unstable angina, and history of pulmonary disease, the coefficients for which were used to develop a preoperative stroke risk index that was validated by bootstrap (c-index = 0.778). Stroke risk could then be determined for each patient, calculating a patient's risk for stroke within 95% confidence intervals.
Conclusions:
With the McSPI stroke risk index developed in this study, neurological risk can be estimated, and the most appropriate group for perioperative therapy can be identified. Further refinement and validation of this index, however, are necessary and are under way in current studies.