Prospective analysis of cerebrovascular events in patients following coronary artery bypass surgery

Authors

  • Lakshmana Kumar Chaitanya Srinivasa Kothamasu Department of Cardiothoracic Surgery, Apollo Hospital, Chennai, Tamil Nadu, India
  • Louis Felix Sridhar Department of Cardiovascular and Thoracic Surgery, Apollo Hospital, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20231434

Keywords:

Cerebro vascular event, Stroke, Coronary artery bypass surgery

Abstract

Background: Cerebrovascular events are the most common cause of disability in adults and can be classified into two categories: ischemic stroke and hemorrhagic stroke. Risk factors for stroke include age, gender, race, family history of stroke, hypertension, smoking, heart disease, valvular heart disease, arrhythmias, diabetes, obesity, and dyslipidemia. Low cardiac output syndrome, myocardial infarction, and atrial fibrillation can also contribute to stroke. This study aims to investigate the incidence of stroke post-cardiac surgery and the risk factors contributing to it.

Methods: A prospective observational study with a sample size of 516 patients was conducted. Patients over the age of 40 who were undergoing CABG (both off and on pump) were included. Patients were subjected to on-pump or off-pump coronary artery bypass surgery as per requirement, but preferably off-pump.

Results: Out of 516 patients, 13 developed strokes, of which 8 (61.5%) had hypertension and 10 (76.9%) had diabetes, 4 (30.8%) were smokers, 6 (46.2%) had normal LDL values, 7 (53.8%) had high LDL levels, none had normal HDL values, 1 (7.7%) had normal LV function, 4 (30.8%) had mild LV dysfunction, 4 (30.8%) had moderate LV dysfunction, and 4 (30.8%) had severe LV dysfunction. 11 (84.6%) had COPD. 7 (53.8%) had no prior MI, 5 (38.5%) had a recent MI, and 1 (7.7%) had a prior MI that was more than ten years old. 8 (61.5%) had normal renal functions, while 5 (38.5%) had disturbed renal functions.

Conclusions: In this study, the incidence of CVE after CABG is 2.52%. All the patients who developed stroke had multiple risk factors. High LDL, low LVEF, deranged renal functions, PVD, arrhythmia pre-op, anti-coagulation pre-op, on pump surgery, Cardioplegia usage, CCF pre-op, urgent surgery, LCOS post-operatively are risk factors for post-operative stroke.

 

References

Coutts SB. Diagnosis and management of transient ischemic attack. CONTINUUM: Lifelong Learning in Neurology. 2017;23(1):82.

Palmerini T, Savini C, Di Eusanio M. Risks of stroke after coronary artery bypass graft–Recent insights and perspectives. Int Cardiol Rev. 2014;9(2):77.

Lee EJ, Choi KH, Ryu JS, Jeon SB, Lee SW, Park SW, et al. Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis. J Am College Cardiol. 2011;57(18):1811.

Hedberg M, Boivie P, Engström KG. Early and delayed stroke after coronary surgery: an analysis of risk factors and the impact on short and long-term survival. Eur J Cardiothorac Surg. 2011;40(2):379-87.

Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, et al. Stroke after coronary artery bypass grafting and percutaneous coronary intervention: incidence, pathogenesis, and outcomes. J Am Heart Asso. 2019;8(13):e013032.

Mao Z, Zhong X, Yin J, Zhao Z, Hu X, Hackett ML. Predictors associated with stroke after coronary artery bypass grafting: a systematic review. J Neurological Sci. 2015;357(1-2):1-7.

Stamou SC, Hill PC, Dangas G, Pfister AJ, Boyce SW, Dullum MK, et al. Stroke after coronary artery bypass: incidence, predictors, and clinical outcome. Stroke. 2001;32(7):1508-13.

Trehan N, Mishra M, Sharma OP, Mishra A, Kasliwal RR. Further reduction in stroke after off-pump coronary artery bypass grafting: a 10-year experience. Ann Thoracic Surg. 2001;72(3):S1026-32.

Rocha RV, Tam DY, Karkhanis R, Wang X, Austin PC, Ko DT, et al. Long-term outcomes associated with total arterial revascularization vs non-total arterial revascularization. JAMA Cardiol. 2020;5(5):507-14.

Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Onnasch JF, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thoracic Surg. 2003;75(2):472- 8.

Selnes OA, Gottesman RF, Grega MA, Baumgartner WA, Zeger SL, McKhann GM. Cognitive and neurologic outcomes after coronary-artery bypass surgery. New-Eng J Med. 2012;366(3):250-7.

Domanski MJ, Farkouh ME, Zak V, Feske S, Easton D, Weinberger J, et al. Predictors of stroke associated with coronary artery bypass grafting in patients with diabetes mellitus and multivessel coronary artery disease. Am J Cardiol. 2015;115(10):1382-8.

Huang L, Kuang F, Shan Z, Lai Y, Guo H. Common factors for ischemic cerebral stroke in coronary artery bypass grafting in patients with concomitant carotid and coronary artery severe stenosis. Zhong nan da xue xue bao. Yi xue ban= Journal of Central South University. Med Sci. 2016;41(12):1340-4.

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Published

2023-05-15

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Original Research Articles