Stroke following coronary artery bypass grafting and long-term outcomes

Stroke is a potentially devastating complication of cardiothoracic surgery, with a reported incidence of between 2% and 10%. While numerous risk factors for stroke have been described, there are limited data on its temporal relationship with the surgical procedure and on whether this predicts long-term outcomes.

In this study, the authors retrospectively analysed data from 7839 isolated coronary artery bypass grafting (CABG) operations—297 off-pump CABG and 986 combined CABG and valve procedures—performed at a single centre between 1994 and 2004. The records of patients with signs of neurological complications were reviewed to identify 149 subjects with stroke at extubation (deemed to have ‘early stroke’, 1.6%) versus 99 patients having a symptom-free interval (deemed to have ‘delayed stroke’, 1.1%). Survival data were then assessed, with a median follow-up time of 9.3 years (maximum, 16.3 years).

Of note, ‘early’ and ‘delayed’ strokes had different risk factors, with patients being at high risk for early stroke if they were of advanced age, had a high preoperative creatinine level, had significant aortic atherosclerosis or had a long cardiopulmonary bypass time (p<0.001 for all). Conversely, factors associated with delayed stroke were as follows: female gender (p<0.001), unstable angina (p=0.003), previous cerebrovascular disease (p=0.009), inotropic requirements (p<0.001) and postoperative atrial fibrillation (p<0.001). Stroke accounted for mortality in the early postoperative period (p<0.001) and on …