Risk factors for early or delayed stroke after cardiac surgery.
BACKGROUND
Stroke after cardiac surgery is a devastating complication that leads to excess mortality and health resource utilization. The purpose of this study was to identify risk factors for perioperative stroke, including strokes detected early after cardiac surgery or postoperatively.


RESULTS
Data were obtained from 2972 patients undergoing coronary artery bypass graft and/or valve surgery. Patients >/=65 years old and those with a history of symptomatic neurological disease underwent preoperative carotid artery ultrasound scanning. Intraoperative epiaortic ultrasound to assess for ascending aorta atherosclerosis was performed in all patients. New strokes were considered as a single end point and were categorized with respect to whether they were detected immediately after surgery (early stroke) or after an initial, uneventful neurological recovery from surgery (delayed stroke). Strokes occurred in 48 patients (1.6%); 31 (65%) were delayed strokes. By multivariate analysis, prior neurological event, aortic atherosclerosis, and duration of cardiopulmonary bypass were independently associated with early stroke, whereas predictors of delayed stroke were prior neurological event, diabetes, aortic atherosclerosis, and the combined end points of low cardiac output and atrial fibrillation. Female sex was associated with a 6.9-fold increased risk of early stroke and a 1.7-fold increased risk of delayed stroke. In-hospital mortality of patients with early (41%) and delayed (13%) strokes was higher than that of other patients (3%, P=0.0001).


CONCLUSIONS
Most strokes after cardiac surgery occurred after initial uneventful recovery from surgery. Women were at higher risk to suffer early and delayed perioperative strokes. Atrial fibrillation had no impact on postoperative stroke rate unless it was accompanied by low cardiac output syndrome.
Hogue
C W
CW
Department of Anesthesiology, Washington University School of Medicine,St. Louis, MO, USA.
Murphy
S F
SF
Schechtman
K B
KB
Dávila-Román
V G
VG
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D001161:Arteriosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000453:epidemiology; D002303:Cardiac Output, Low / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000009:adverse effects