Key result
Elective coronary artery bypass grafting was associated with a 1.4% incidence of adverse cerebral outcomes, with prior stroke (OR 6.27; 95% CI 1.78-22.03) significantly increasing this risk.
Why the study?
What is the incidence and what are the predictors of adverse cerebral outcomes after elective coronary artery bypass grafting?
Cohort (n=1,108)
No
What is the incidence and what are the predictors of adverse cerebral outcomes after elective coronary artery bypass grafting?
A low incidence of adverse cerebral outcomes (1.4%) after CABG can be achieved in a community hospital setting, with older age, heart failure, and prior stroke identified as key risk factors.
Prior stroke warrants heightened neuroprotection in elective CABG; extends observational risk data but leaves causal confirmation and practice change open.
BACKGROUND: Nonfatal strokes, transient ischemic attacks (TIAs), and reversible ischemic neurological deficits (RIND) after elective coronary artery bypass grafting (CABG) are devastating clinical problems. The anesthesiologist, surgical and intensive care teams in a community hospital adopted a strategy developed in an effort to minimize these adverse outcome events.The purpose of this study is to determine the incidence of and predictors for perioperative adverse neurologic events. METHODS: A historical cohort study of 1,108 consecutive CABG patients operated between 2002 and 2014. Outcomes were defined as (1) a new neurologic damage (a new stroke, TIA, or RIND) and (2) a new neurologic damage or 30 days mortality. RESULTS: Adverse cerebral outcomes occurred in 16 patients (1.4 percent). Nine patients had postoperative stroke, six suffered TIAs, and one had postoperative RIND.In multivariate analysis, older age (OR 1.07, 95% CI 1.01-1.14), congestive heart failure (OR 3.57, 95% CI 1.22-10.49) and prior stroke (OR 6.27, 95% CI 1.78-22.03) were significantly associated with increased risk of new neurologic damage. These parameters were also significantly associated with increased risk of the combined outcome (new neurologic damage/mortality). CONCLUSIONS: A low incidence rate of adverse cerebral outcomes after CABG in community hospital can be achieved with the use of the suggested surgical intensive care, and anesthetic strategy. Advanced age, congestive heart failure, and prior stroke are associated with adverse outcomes.
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Consalvi et al. (2018) conducted a cohort in Elective coronary artery bypass grafting (CABG) (n=1,108). Elective coronary artery bypass grafting (CABG) was evaluated on New neurologic damage (a new stroke, TIA, or RIND). Elective coronary artery bypass grafting was associated with a 1.4% incidence of adverse cerebral outcomes, with prior stroke (OR 6.27; 95% CI 1.78-22.03) significantly increasing this risk.