Risk factors of stroke and delirium after off-pump coronary artery bypass surgery

Abstract

Off-pump coronary artery bypass surgery (CABG) has not abolished the risk of postoperative stroke and delirium seen for on-pump CABG. Advanced arteriosclerotic changes are common in both on-pump and off-pump CABG. We sought to analyze if advanced arteriosclerotic changes are risk factors of stroke or transient ischemic attack (TIA), and delirium after off-pump CABG. Patients undergoing off-pump CABG between 2001 and 2005 were reviewed using medical records (n=685). Potential risk factors of postoperative stroke and delirium were identified from previous studies. Further, variables retrieved from carotid artery duplex scanning as indices of advanced arteriosclerosis, were examined. The incidences of postoperative stroke/TIA and delirium after off-pump CABG were 2.6% (n=18) and 16.4% (n=112), respectively. Carotid artery stenosis >50% was a significant risk factor of stroke or TIA (P=0.02) as well as delirium (P=0.04) after off-pump CABG. A history of atrial fibrillation (AF) (P=0.037) or diabetes mellitus (P=0.041) was a risk factors of postoperative stroke or TIA. In contrast, age over 75 years (P=0.006), creatinine >1.3 mg/dl (99 μmol/l) (P=0.011), a history of hypertension (P=0.001), past history of AF (P=0.024), and smoking (P=0.048) were significant risk factors of postoperative delirium.

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

“…13 Embolic signals measured using TCD were even observed in patients with asymptomatic carotid artery stenosis, resulting in silent cerebral infarction. 14,15 Significant atherosclerosis, manifesting as carotid stenosis or ascending aortic plaque, was also associated with delirium after CABG.…”

“…Using a power of 80%, a 5% two-sided significance level, and a 2.5 ratio of patients with carotid artery stenosis to patients without carotid artery stenosis, with a 2.0 relative risk of delirium in those with carotid stenosis, 13 our final sample size was estimated to be 370. Continuous variables are presented as the mean (SD), and discrete variables are presented as the frequency and percentages.…”

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

“…For achieving a preoperative fasting blood glucose level of 140 mg/dl and a postoperative level of 200 mg/dl, DM patients were aggressively treated with intensive insulin Miyazaki, et al 35) studied risk factors of stroke/transient ischemic attack (TIA) and delirium after OPCAB. The medical records of patients (n = 685) who underwent OPCAB were reviewed.…”

Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting

“…Cerebral injury is a devastating complication of CABG; globally, stroke occurs in 1.5-7.6% of the patients, encephalopathy affects 8.4-32% of those, and cognitive dysfunction affects 20-65% of the patients at discharge [1][2][3][4]20]. Variation in the incidences reported by different studies is likely due to differences in the patient samplings (e.g., patient age and risk status, types of procedures), diagnostic definitions, and intensity of clinical surveillance.…”

“…Devastating CNS complications, including stroke, can occur following coronary artery bypass grafting (CABG), with an incidence of 2.6-7.6% [1,2]. Cognitive dysfunction (with an incidence of 30-65%) [3,4], anxiety, and depression are also among such complications.…”