A multicentre Spanish study for multivariate prediction of perioperative in-hospital cerebrovascular accident after coronary bypass surgery: the PACK2 score

Hornero, Fernando; Martín, E.; Rodríguez, Rafael; Castellá, Manel; Porras, Carlos; Romero, Bernardo Prida; Maroto, Luis; Sota, Enrique Pérez de la

doi:10.1093/icvts/ivt102

Cited by 18 publications

(16 citation statements)

References 6 publications

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“…In the Charlesworth score, generated from 33,000 consecutive patients undergoing isolated CABG, seven variables are integrated, including age, diabetes, left ventricular ejection fraction <40 %, female gender, priority of surgery, renal dysfunction and peripheral vascular disease. 22 23 Interestingly, in patients with Pack 2 score ≥2, off-pump CABG significantly reduced the risk of stroke compared with on-pump CABG, whereas no difference was apparent between the two strategies of revascularisation in patients with Pack 2 score <2. Further studies should externally validate this score and assess whether it is useful in clinical practice to select the optimal strategy of revascularisation between on-pump and off-pump CABG in high-risk patients.…”

Section: Risk Stratificationmentioning

confidence: 98%

“…Age, diabetes, hypertension, peripheral vascular disease, renal failure, left ventricular dysfunction and non-elective surgery have consistently been reported as risk factors of peri-operative stroke in patients undergoing CABG surgery. 22,23 All these risk factors can be assessed before surgery, so the information can assist informed decision-making by patients, their family and their physicians. The combination of these variables has generated several risk stratification tools that can be implemented before surgery, to determine the individual probability of stroke in patients undergoing CABG.…”

Section: Risk Stratificationmentioning

confidence: 99%

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Risks of Stroke After Coronary Artery Bypass Graft – Recent Insights and Perspectives

Palmerini¹,

Savini

Eusanio

2011

Interventional Cardiology Review

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Stroke is one of the most devastating complications after coronary artery bypass graft (CABG) surgery, entailing permanent disability, a 3-6 fold increased risk of mortality, an incremental hospital resource consumption and a longer length of hospital stay. Notwithstanding advances in surgical, anaesthetic and medical management across the last 10 years, the risk of stroke after CABG has not significantly declined, likely because an older and sicker population is now deemed suitable to undergo CABG. The pathogenesis of stroke is multifactorial, but two variables are believed to play a major role - cerebral embolisation of atheromatous debris arising from the ascending aorta during surgical manipulation and hypoperfusion during surgery. Identification of vulnerable patients at increased risk of stroke before CABG is of paramount importance for the surgical decision-making approach and informed consent. Several models including demographic, clinical and procedural variables have been developed to risk-stratify the hazard of stroke in patients undergoing CABG, but identification of severe atherosclerosis of the ascending aorta and pre-existing cerebrovascular disease are key determinants for appropriate risk stratification and decision-making. Atherosclerotic disease of the ascending aorta can be identified before surgery using transoesophageal echocardiography, computed tomography and magnetic resonance imaging. However, intra-operative ultrasound scanning of the ascending aorta is the diagnostic tool with the best sensitivity and specificity for the detection of atheromatous debris in the ascending aorta. Although many investigators have advocated the use of off-pump CABG to minimise the risk of peri-operative stroke, results from randomised trials and meta-analyses have been inconsistent. Anaortic approaches, including total arterial revascularisation with grafting of both mammary arteries, or the use of the HEARTSTRING® seal device avoid any manipulation of the aorta, thus potentially minimising the risk of stroke in high-risk patients. Assessment and treatment of severe carotid artery disease, and aggressive and prompt treatment of post-operative atrial fibrillation are other important strategies that should be routinely implemented to reduce the risk of stroke in patients undergoing CABG.

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Section: Risk Stratificationmentioning

confidence: 98%

Section: Risk Stratificationmentioning

confidence: 99%

Risks of Stroke After Coronary Artery Bypass Graft – Recent Insights and Perspectives

Palmerini¹,

Savini

Eusanio

2011

Interventional Cardiology Review

View full text Add to dashboard Cite

show abstract

“…The closer in time the index event, the higher the IHS risk: four out of five strokes after MI occur during the first five days 21 . The absolute periprocedural or -operative risk to suffer from IHS is about 0.25% in PCI 17 , 0.9% after acute coronary events 22 and about 1.4% after CABG 23 .…”

Section: Etiology Risk Factors and Outcomementioning

confidence: 99%

In-hospital stroke

Reich¹

2017

J Neurol Neuromedicine

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“…Hyperglycemia affects the clinical outcomes after cardiac surgery. [ 3 4 5 6 7 8 9 10 11 12 13 ] Therefore, it is desirable to control hyperglycemia to improve prognosis. However, the risk of hypoglycemia becomes a limiting factor.…”

Section: Introductionmentioning

confidence: 99%

Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India

Bansal

Mithal

Carvalho³

et al. 2015

Indian J Endocr Metab

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Aim:Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients.Materials and Methods:Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG) data captured from blood gas analyzers (glucometrics) in the intervention group (i.e., after protocol implementation) were compared to control group (i.e., before the protocol implementation).Results:The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation.Conclusion:A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.

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A multicentre Spanish study for multivariate prediction of perioperative in-hospital cerebrovascular accident after coronary bypass surgery: the PACK2 score

Abstract: PACK2 risk scale shows good predictive accuracy in the data analysed and could be useful in clinical practice for decision making and patient selection.

Cited by 18 publications

References 6 publications

Risks of Stroke After Coronary Artery Bypass Graft – Recent Insights and Perspectives

Risks of Stroke After Coronary Artery Bypass Graft – Recent Insights and Perspectives

In-hospital stroke

Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India

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