To assess the risk factors for stroke (CVA) in patients undergoing coronary artery bypass graft surgery(CABG).METHODS: We conducted a nested case-control study from a nine-year, prospective hospitalization cohort (N=6245). Data were collected on 225 variables prospectively during admission. Inclusion in the cohort included CABG between 10/93 and 6/02. Exclusion criteria included any other simultaneously performed surgery. Patients were followed for thirty days after surgery. Cases were defined as patients who underwent CABG and had a CVA, (171 cases, 2.7% of total), and controls were patients who underwent CABG without a CVA. Cases were matched to controls 1:3 (513 controls). The thirty-eight predictor variables were pump time, body surface area, creatinine, previous PTCA, clamp time, coronary perfusion time, previous cardiac surgeries, hypertension, race, gender, prior myocardial infarction, family history of coronary disease, cerebrovascular disease history, pre-operative neurologic disease, pulmonary hypertension, aortic disease, previous intervention in 30 days, angina history, bleeding history, prior vascular surgery, diabetes, age, myocardial findings, chronic obstructive pulmonary disease, New York Heart Association functional class, prior gastrointestinal disease, current vascular disease, systemic diseases, vessels at last PTCA, PTCA result, current smoking, tobacco history, dialysis, current anticoagulants, character of operation, left ventricular hypertrophy, hypercholesterolemia, and chronic corticosteroids.RESULTS: There were fifteen significant predictors of stroke. Twelve of the variables correlated significantly with one of three final predictor variables. We conducted logistic regression analysis to assess the risk for each significant predictor: age greater than seventy (RR 4.61, 95%CI 2.84–6.07), worse pre-op neurological status (RR 4.24, 95%CI 2.02–5.79), and previous cardiac surgery (RR 1.75, 95%CI 1.05–2.91).CONCLUSIONS: In patients undergoing CABG the significant predictors for stroke, in order of risk are age greater than seventy, then worse pre-operative neurological status, followed by previous cardiac surgery.CLINICAL IMPLICATIONS: Patients considering CABG surgery with these risk factors need to be counseled as to their individual risk of CVA. A patient with all three risk factors would possess a 25% chance of CVA folowing CABG surgery.
S.E. Woods, None.