Perioperative stroke in coronary artery bypass surgery. Analysis of risk factors.
The incidence of neurologic complications after coronary bypass surgery is steadily rising as older and sicker patients are increasingly being treated. To identify patients requiring special attention, we reviewed the records in 2263 consecutive cases of first-time coronary artery bypass grafting in 1993-1995, in order to find predictive factors for stroke. Significant factors in univariate analysis were patient age, peripheral vascular disease, cerebrovascular disease, renal failure (defined as serum creatinine > or = 150 micromol/l), aneurysmal disease of the abdominal aorta, stenosis of the left main coronary artery, urgent or emergency operation, NYHA class, cardiopulmonary bypass time, number of aortic anastomoses, intraoperatively detected loose or calcified atheromatosis of the ascending aorta, left ventricular venting, intra-aortic balloon counterpulsation, cardiac complications necessitating early reoperation, and perioperative myocardial infarction. In a multivariate analysis, age, renal failure, cerebrovascular disease, peripheral vascular disease, NYHA class, number of aortic anastomoses, perioperative myocardial infarction and intraoperatively detected loose atheromatosis of the ascending aorta remained significant.
Saimanen
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Department of Cardiothoracic Surgery, Helsinki University Hospital, Finland.
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications*; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate