Key result
Peripheral arterial disease was identified as the strongest independent risk factor for postoperative stroke after coronary bypass surgery with cardiopulmonary bypass, increasing the risk by over 5-fold.
Why the study?
What are the independent risk factors for postoperative stroke in patients undergoing isolated coronary surgery with cardiopulmonary bypass?
Cohort (n=3,248)
No
What are the independent risk factors for postoperative stroke in patients undergoing isolated coronary surgery with cardiopulmonary bypass?
Stroke after coronary bypass surgery is strongly associated with markers of diffuse atherosclerotic disease, including peripheral arterial disease and severe coronary artery disease.
May inform preoperative stroke risk counseling for CABG patients with PAD; extends observational associations but leaves causal impact open.
OBJECTIVE: This study aims to investigate the risk factors for postoperative stroke and analysis of outcome after coronary bypass surgery with cardiopulmonary bypass. METHODS: Between 1999 and 2008, 3248 consecutive patients who underwent isolated coronary surgery with cardiopulmonary bypass were prospectively enrolled in the study. Demographic and perioperative data were analyzed. Postoperative stroke was defined as severe adverse neurological events including permanent deficits or cerebral lesions with radiological demonstration of cerebral infarction within the first postoperative month. RESULTS: In total, 32 patients (0.9%) were determined with stroke. Univariate risk factors for postoperative stroke were determined as preoperative unstable angina (P = .006), Canadian Class of Angina (CCA) ≥ 3 (P = .001), preoperative creatinin level >1.2 mg/dL (P = .001), left main coronary artery disease (P = .04), chronic obstructive lung disease (P = .04), peripheral arterial disease (P < .001), New York Heart Association (NYHA) Class ≥ 3 (P = .004), preoperative renal insufficiency (P = .001), age > 65 years (P = .04), preoperative hypothyroidism (P = .02), postoperative low cardiac output state (P < .001), severe coronary artery disease requiring distal anastomosis ≥ 4 (P = .05), non-elective operation (P = .02), and body mass index ≥ 25 (P = .02). Multivariate analysis revealed peripheral arterial disease (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.9-14.0; P = .001), severe coronary artery disease (OR, 3.1; 95% CI, 1.1-8.5; P = .02), and postoperative low cardiac output state (OR, 5.1; 95% CI, 1.4-18.2; P = .01) as the independent risk factors. CONCLUSIONS: Stroke after coronary bypass surgery with cardiopulmonary bypass is mainly related to diffuse atherosclerotic disease.
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Şenay et al. (2011) conducted a cohort in Coronary Artery Disease requiring Coronary Artery Bypass Grafting (n=3,248). Peripheral arterial disease vs. No peripheral arterial disease was evaluated on Postoperative stroke within the first postoperative month (OR 5.2, 95% CI 1.9-14.0, p=0.001). Peripheral arterial disease was identified as the strongest independent risk factor for postoperative stroke after coronary bypass surgery with cardiopulmonary bypass, increasing the risk by over 5-fold.
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