Predictors of stroke in patients undergoing cardiac surgery

Abstract

ObjectiveTo determine the risk factors related to the development of stroke in patients undergoing cardiac surgery.MethodsA historical cohort study. We included 4626 patients aged > 18 years who underwent coronary artery bypass surgery, heart valve replacement surgery alone or heart valve surgery combined with coronary artery bypass grafting between January 1996 and December 2011. The relationship between risk predictors and stroke was assessed by logistic regression model with a significance level of 0.05.ResultsThe incidence of stroke was 3% in the overall sample. After logistic regression, the following risk predictors for stroke were found: age 50-65 years (OR=2.11 - 95% CI 1.05-4.23 - P=0.036) and age >66 years (OR=3.22 - 95% CI 1.6-6.47 - P=0.001), urgent and emergency surgery (OR=2.03 - 95% CI 1.20-3.45 - P=0.008), aortic valve disease (OR=2.32 - 95% CI 1.18-4.56 - P=0.014), history of atrial fibrillation (OR=1.88 - 95% CI 1.05-3.34 - P=0.032), peripheral artery disease (OR=1.81 - 95% CI 1.13-2.92 - P=0.014), history of cerebrovascular disease (OR=3.42 - 95% CI 2.19-5.35 - P<0.001) and cardiopulmonary bypass time > 110 minutes (OR=1.71 - 95% CI 1.16-2.53 - P=0.007). Mortality was 31.9% in the stroke group and 8.5% in the control group (OR=5.06 - 95% CI 3.5-7.33 - P<0.001).ConclusionThe study identified the following risk predictors for stroke after cardiac surgery: age, urgent and emergency surgery, aortic valve disease, history of atrial fibrillation, peripheral artery disease, history of cerebrovascular disease and cardiopulmonary bypass time > 110 minutes.

To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting

“…This may be due to a very small proportion of our cohort having a prolonged CPB time as a whole and therefore little representation of that particular population in our results. 24 , 25 …”

Association of Timing of Aortic Valve Replacement Surgery After Stroke With Risk of Recurrent Stroke and Mortality

“…Numerous studies have indicated that previous stroke is an independent predictor for postoperative stroke and mortality. 6,[34][35][36][37][38][39][40] In 2008, Gulbins et al 41 presented a hazard ratio of 2.6 for postoperative stroke among patients with a history of stroke receiving a stentless aortic valve; however, the follow-up began 6 months after surgery. In 2013, Bottle et al 39 performed a study on preoperative stroke and outcomes after CABG surgery.…”

Mechanical Thrombectomy for Acute Ischemic Stroke After Cardiac Surgery

“…The incidence of stroke after cardiac surgery is between 1.7% to 4.6%, with approximately 60% of patients presenting with symptoms immediately after surgery [ 2 , 5 - 8 ]. This incidence varies with the procedure: CABG 1.7%, isolated valve 1.8%-3.6%, valve with CABG 3.3%-4.4%, ascending aortic graft 4.6%, congenital 1.0%, and ventricular assist device or transplant 6.2% [ 2 , 5 ].…”

“…Several studies have looked at the risk factors and predictors of stroke in patients undergoing cardiac procedures. Positive correlators include age 50-65 (odds ratio [OR] = 2.11), age greater than 65 (OR = 3.22), urgent and emergency surgery (OR = 2.03), aortic valve disease (OR = 2.32), history of atrial fibrillation (OR = 1.88), peripheral artery disease (OR = 1.81), history of cerebrovascular disease (OR = 3.42) and cardiopulmonary bypass time > 110 minutes (OR = 1.71) [ 8 ].…”