Original article: cardiovascular
Magnetic resonance imaging findings and postoperative neurologic dysfunction in elderly patients undergoing coronary artery bypass grafting

https://doi.org/10.1016/S0003-4975(01)02676-5Get rights and content

Abstract

Background. Small cerebral infarctions are common in elderly patients, but the association between the magnetic resonance imaging finding and neurologic dysfunction after coronary artery bypass grafting has not been evaluated.

Methods. We determined, prospectively, whether varying degrees of abnormal findings on magnetic resonance images of the brain increased the incidence of preoperative cognitive decline, postoperative neuropsychological dysfunction, and stroke in 421 elderly patients (≥ 60 years) undergoing coronary artery bypass grafting.

Results. Control patients (almost normal or leukoaraiosis, n = 212) had rates of postoperative neuropsychological dysfunction (7%) and stroke (1.4%); the small infarctions group (some small infarctions, n = 126) had rates of 13% and 5.6%, respectively; whereas patients with multiple infarctions (multiple small infarctions or broad infarctions, n = 83) had rates of 20% and 8.4%, respectively (p = 0.004, p = 0.013). In the group with multiple infarctions, 49 patients (59%) were asymptomatic and 21 patients (25%) had cognitive decline. Stepwise logistic regression analysis demonstrated that the significant predictors of multiple small infarctions or large infarctions were history of cerebrovascular disease, renal insufficiency, cognitive decline, and cerebral arteriosclerosis.

Conclusions. Multiple infarctions significantly increase the risk of neurologic dysfunction after coronary artery bypass grafting. Routine screening for preoperative cognitive decline should be performed to detect underlying ischemic cerebral disease in elderly patients.

Section snippets

Material and methods

Data were prospectively collected on 421 Japanese patients older than 60 years who underwent elective CABG by a single surgeon at Kumamoto Chuo Hospital between January 1995 and June 1999. There were 351 asymptomatic patients who had no history of stroke or transient ischemic attack, and 71 with a history of stroke or transient ischemic attack. Patients who underwent cardiac valve replacement or ventricular aneurysmectomy were excluded to eliminate the effects of intracardiac air embolism and

Results

Of the 421 patients studied, 126 patients (30%) had small infarctions, and 83 (20%) had multiple infarctions; of the latter, 72 had multiple small infarctions, and 11 had broad infarctions. There was an increase in infarctions with age compared with control patients (p = 0.052). Preoperative and intraoperative characteristics for all patients are summarized in Table 1. In general, the patients with multiple infarctions had more atherosclerotic risk factors than the patients in the other two

Comment

The incidence of NP dysfunction and stroke after CABG was demonstrated to increase in patients who had a higher grade of MRI finding in the brain. Multivariate analysis confirmed that the independent risks for multiple infarctions and broad infarctions were history of CVD, renal insufficiency, cognitive decline, and cerebral arteriosclerosis.

Small cerebral infarctions are common in elderly patients undergoing CABG [6]. Of 83 patients with multiple small infarctions or broad infarctions, 49

Acknowledgements

The authors thank Yasuhiko Matsukado, MD, for his critical comments and suggestions, and Jon Moon, MD, for his editorial assistance.

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