Meta-Analysis of Perioperative Stroke and Mortality in CABG Patients With Carotid Stenosis

BACKGROUND: Coronary artery bypass grafting (CABG) is a proven approach in the treatment of coronary heart disease, but the surgery has several complications, including stroke and death. Though it has been established that perioperative stroke is associated with higher rates of long-term mortality, the relationship between stroke and mortality in the perioperative period has not yet been systematically examined. METHODS: Online databases of peer-reviewed literature were searched to retrieve articles concerning mortality and stroke after CABG in patients with carotid stenosis. Six studies (n=3786) were included for analysis. This study was conducted at a single University hospital system, University of Pittsburgh Medical Center, on patients who underwent CABG. The data obtained from peer-reviewed literature originated from several sources, primarily single institution hospitals. RESULTS: Consistent with current literature, the incidence of stroke in CABG patients with significant carotid stenosis was 2.1%. Data were further analyzed to generate a summary odds ratio of stroke-related mortality after CABG, which showed that patients who died within 30 days of CABG were 7.3 times more likely to have had a perioperative stroke (95% confidence interval, 4.1-13.2). The 30-day mortality rate among perioperative stroke victims was 14.4% versus 2.3% for nonstroke patients. CONCLUSIONS: Together, these data suggest an association between stroke and mortality in the perioperative period in patients undergoing CABG, demonstrating a need for improved monitoring, screening, and treatment of stroke before, during, and shortly after surgery.