Risk factors for stroke after cardiac surgery: Buffalo Cardiac-Cerebral Study Group

Ricotta, John J.; Faggioli, Gianluca; Castilone, Alice; Hassett, James M.

doi:10.1016/s0741-5214(95)70276-8

Cited by 183 publications

(98 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The prevalence of carotid stenosis ≥ 50% in patients undergoing cardiac surgery (CABG; CABG + valve surgery) ranges from 3.8% to 22%. [15][16][17][18][19][20] The presence of significant (≥ 70%) internal carotid artery stenosis in our Correlates of carotid stenosis in CABG patients 235 study was 7.7%. Selectively screening patients with carotid artery DUS, as opposed to screening every patient > 65 years old, would provide a more streamlined and cost-effective approach to carotid DUS prior to CABG.…”

Section: Discussionmentioning

confidence: 77%

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

et al. 2009

View full text Add to dashboard Cite

Carotid duplex ultrasonography (DUS) is routinely performed prior to coronary artery bypass graft surgery (CABG) on all patients > 65 years old because of the reported associated risk of finding concomitant carotid artery stenosis. Identifying risk factors that correlate with severe carotid stenosis may result in more costeffective screening for patients with asymptomatic carotid artery disease prior to CABG. We performed a retrospective study to identify risk factors for significant carotid artery disease in patients scheduled to undergo CABG between March 2005 and March 2008 at the Massachusetts General Hospital. Patients with carotid stenosis ≥ 70% identified by DUS (n = 50) were matched by age and sex to control patients who had < 50% stenosis (n = 50). Data were analyzed using the chi-squared test or analysis of variance as appropriate. Logistic regression was used to examine multivariate correlates of carotid stenosis. A total of 643 patients were screened to arrive at the patient cohorts described below. This produced a prevalence of 7.7% for significant (> 70%) carotid disease. The patient cohorts were predominantly male with no significant difference in the incidence of diabetes, hypertension, extent of coronary artery disease (CAD) (i.e. left main coronary artery disease (LMCA) and one, two-, or three-vessel CAD) or lipid abnormalities in the two groups. Univariate analysis identified the presence of peripheral arterial disease (PAD, p = 0.001), a cervical bruit (p < 0.0001), a prior neurological event (p = 0.020), and the presence of an abdominal aortic aneurysm (AAA; p = 0.046) as significant predictors of ≥ 70% internal carotid artery stenosis. Logistic regression analysis revealed that the presence of a carotid bruit (p = 0.0068) and PAD (p = 0.0194) were associated with an increased risk of significant carotid artery disease. In conclusion, the presence of a carotid bruit or PAD predicts an increased likelihood of significant carotid artery disease in patients undergoing CABG. Unlike previous studies, LMCA or extent of CAD did not correlate with significant carotid artery disease. Using these predictive models, a prospective outcomes trial is required to validate these criteria.

show abstract

Section: Discussionmentioning

confidence: 77%

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Although other series have variations in the type and frequency of risk factors associated with post-CAB stroke, all of the significant risk factors identified in this study have been cited by others to contribute to increased post-CAB stroke. [3][4][5][6][7][8] Risk-adjusted stroke ratesϭobserved/expectedϫstroke rate of reference population. In the case of model I this was 1.7%.…”

Section: Discussionmentioning

confidence: 99%

Modeling Stroke Risk After Coronary Artery Bypass and Combined Coronary Artery Bypass and Carotid Endarterectomy

Ricotta

Char

Cuadra

et al. 2003

Stroke

Self Cite

View full text Add to dashboard Cite

Background and Purpose-The goals of this study were to compare the ability of statewide and institutional models of stroke risk after coronary artery bypass (CAB) to predict institution-specific results and to examine the potential additive stroke risk of combined CAB and carotid endarterectomy (CEA) with these predictive models. Methods-An institution-specific model of stroke risk after CAB was developed from 1975 consecutive patients who underwent nonemergent CAB from 1994 to 1999 in whom severe carotid stenosis was excluded by preoperative duplex screening. Variables recorded in the New York State Cardiac Surgery Program database were analyzed. This model (model I) was compared with a published model (model II) derived from analysis of the same variables using New York statewide data from 1995. Predicted and observed stroke risks were compared. These formulas were applied to 154 consecutive combined CAB/CEA patients operated on between 1994 and 1999 to determine the predicted stroke risk from CAB alone and thereby deduce the maximal added risk imputed to CEA. Results-Risk factors common to both models included age, peripheral vascular disease, cardiopulmonary bypass time, and calcified aorta. Additional risk factors in model I also included left ventricular hypertrophy and hypertension. Risk factors exclusive to model II included diabetes, renal failure, smoking, and prior cerebrovascular disease. Our observed stroke rate for isolated CAB was 1.7% compared with a rate predicted with model II (statewide data) of 1.56%. The observed stroke rate for combined CEA/CAB was 3.9%. When the Stony Brook model (model I) based on patients without carotid stenosis was used, the predicted stroke rate was 2.8%. When the statewide model (model II), which included some patients with extracranial vascular disease, was used, the predicted stroke rate was 3.4%. The differences between observed and predicted stroke rates were not statistically significant. Conclusions-Estimation of stroke risk after CAB was similar whether statewide data or institution-specific data were used. The statewide model was applicable to institution-specific data collected over several years. Common risk factors included age, aortic calcification, and peripheral vascular disease. The observed differences in the predicted stroke rates between models I and II may be due to the fact that carotid stenosis was specifically excluded by duplex ultrasound from the patient population used to develop model I. Modeling stroke risk after CAB is possible. When these models were applied to patients undergoing combined CAB/CEA, no additional stroke risk could be ascribed to the addition of CEA. Such models may be used to identify groups at increased risk for stroke after both CAB and combined CAB/CEA. The ultimate place for CEA in patients undergoing CAB will be defined by prospective randomized trials. (Stroke. 2003; 34:1212-1217.)

show abstract

“…Carotid artery stenosis greater than 50%, redo surgery, peripheral vascular disease, longer pump time, and hypercholesterolemia were found to be independently associated with an increased risk of stroke and mortality. 13) D'Agostino, et al assessed the incidence and risk factors for stroke in 1835 patients undergoing CABG and found that carotid stenosis >50% was a risk factor in this population. 14) Salasidis, et al found that the incidence of postoperative neurologic events in patients with severe carotid disease (>80% stenosis) was 18.2% and 1.7% in patients without severe carotid disease.…”

Section: Discussionmentioning

confidence: 99%

<b>Coronary Artery Bypass and Carotid Endarterectomy</b>

et al. 2001

View full text Add to dashboard Cite

SUMMARYControversy exists concerning the best management of patients with coronary artery and carotid artery disease. Between June 1994 and July 2000, 88 patients with coronary artery and carotid artery disease underwent combined coronary artery surgery and carotid endarterectomy. Demographics and perioperative variables of these patients were compared with those of 266 patients undergoing isolated coronary artery surgery. Patients in the combined coronary artery bypass grafting and carotid endarterectomy group were elderly patients (p=0.0001) with a higher prevalence of female gender (p=0.0001), left ventricular dysfunction (p=0.006), left main coronary artery disease (p=0.033), triple-vessel coronary artery disease (p=0.002), unstable angina pectoris (p=0.004), and history of prior neurologic events (p=0.0001). Three (3.4%) patients in the combined group and 5 (1.9%) patients in the isolated coronary artery surgery group (p=0.317) developed perioperative myocardial infarction. Two (2.3%) patients in the combined group developed a permanent postoperative neurologic event. Hospital mortality was 5.7% (5 patients) in the combined coronary artery bypass grafting and carotid endarterectomy group and 1.5% (4 patients) in the isolated coronary artery surgery group (p=0.046).Patients with concomitant carotid and coronary artery disease have an advanced arteriosclerosis. Although combined coronary artery bypass grafting and carotid endarterectomy is associated with a higher risk of death and perioperative myocardial infarction than simple coronary artery surgery, this procedure is a preferable approach for these high-risk patients and results in lower neurologic morbidity. (Jpn Heart J 2001; 42: 539-552)

show abstract

Risk factors for stroke after cardiac surgery: Buffalo Cardiac-Cerebral Study Group

Cited by 183 publications

References 13 publications

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting – a case control study

Modeling Stroke Risk After Coronary Artery Bypass and Combined Coronary Artery Bypass and Carotid Endarterectomy

<b>Coronary Artery Bypass and Carotid Endarterectomy</b>

Contact Info

Product

Resources

About