Key result
The presence of five risk factors—carotid plaque score ≥5.1, stenosis ≥75%, echolucent plaque, peripheral artery disease, and creatinine ≥1.5 mg/dL—predicted silent cerebral infarction with a probability of 0.99 in elderly CABG patients.
Why the study?
Do ultrasonographic features of carotid arteries combined with clinical factors predict silent cerebral infarction in elderly patients undergoing CABG?
Observational (n=400)
No
Do ultrasonographic features of carotid arteries combined with clinical factors predict silent cerebral infarction in elderly patients undergoing CABG?
Preoperative carotid ultrasound features, particularly when combined with peripheral artery disease and elevated creatinine, can effectively predict the risk of silent cerebral infarction in elderly patients undergoing CABG.
May aid preoperative risk stratification in elderly CABG patients; leaves open prospective validation before clinical adoption.
Background : Stroke can be a devastating complication after coronary artery bypass grafting (CABG). Silent cerebral infarction (SCI) is common in elderly patients, and – like previous cerebrovascular disease (CVD)– is a risk factor for stroke. We examined the ultrasonographic features of the carotid arteries as predictors of SCI in patients undergoing CABG.Methods : Data for 633 CABG patients aged ≥ 60 yr were collected, and the patients were divided into three groups : control (n = 348), SCI (n = 175), and CVD (n = 110). We compared the images of carotid plaque, and the risk factors and incidence of stroke among the three groups, and calculated the probability of SCI.Results : In the SCI group, the plaque score (PS) was 7.7 ± 4.7, the incidence of carotid stenosis (> 75%) was 13%, that of echolucent plaque was 37%, that of cerebral artery stenosis (> 50%) was 26%, and that of severe aortic atherosclerosis was 19%, being almost equal to the data for the CVD group. The incidence of stroke was 6.4% in the CVD group, 4.5% in the SCI group, and 1.4% in the control group (P < 0.05). Univariate analysis revealed that 5 factors were correlated with SCI : PS > 5.1, stenosis > 75%, echolucent plaque, peripheral artery disease (PAD), and creatinine ≥ 1.5 mg/dL. The probability of SCI in patients with all 5 risk factors was 0.77.Conclusions : Ultrasonographic features combined with PAD and creatinine would be useful for prediction of SCI.
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Koyanagi et al. (2012) conducted an observational in Silent cerebral infarction (SCI) after coronary artery bypass grafting (n=400). Carotid ultrasonographic features (plaque score ≥5.1, stenosis ≥75%, echolucent plaque), peripheral artery disease, and creatinine ≥1.5 mg/dL vs. Absence of these risk factors was evaluated on Probability of silent cerebral infarction (SCI). The presence of five risk factors—carotid plaque score ≥5.1, stenosis ≥75%, echolucent plaque, peripheral artery disease, and creatinine ≥1.5 mg/dL—predicted silent cerebral infarction with a probability of 0.99 in elderly CABG patients.
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