Stroke after cardiac surgery: short- and long-term outcomes.
BACKGROUND
Stroke remains a devastating complication of cardiac surgery, but stroke prevention remains elusive. Evaluation of early and long-term clinical outcomes and brain-imaging findings may provide insight into stroke prognosis, etiology, and prevention.


METHODS
Five thousand nine hundred seventy-one cardiac surgery patients were prospectively studied for clinical evidence of stroke. Stroke and nonstroke patients were compared by early outcomes. Data collected for stroke patients included brain imaging results, long-term functional status, and survival. Outcome predictors were then determined.


RESULTS
Stroke was diagnosed in 214 (3.6%) patients. Brain imaging demonstrated acute infarction in 72%; embolic in 83%, and watershed in 24%. Survival for stroke patients was 67% at 1 year and 47% at 5 years. Independent predictors of survival were cerebral infarct type, creatinine elevation, cardiopulmonary bypass time, preoperative intensive care days, postoperative awakening time, and postoperative intensive care days. Long-term disability was moderate to severe in 69%.


CONCLUSIONS
Stroke after cardiac surgery has profound repercussions that are independently related to infarct type and clinical factors. These data are essential for clinical decision making and prognosis determination.
Salazar
J D
JD
Department of Neurology, The Johns Hopkins University, Baltimore, Maryland, USA.
Wityk
R J
RJ
Grega
M A
MA
Borowicz
L M
LM
Doty
J R
JR
Petrofski
J A
JA
Baumgartner
W A
WA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002544:Cerebral Infarction / Q000401:mortality*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate