title: Chronic exposure to nicotine does not prevent neurocognitive decline after cardiac surgery.
abstract: OBJECTIVE
  To establish the association between smoking and cognitive decline in patients undergoing coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Referral center for cardiothoracic surgery at a university hospital.
  
  
  METHODS
  Four hundred seventeen patients undergoing CABG surgery.
  
  
  METHODS
  Based on preoperative data, patients were divided into 2 groups: smokers (n = 185) and nonsmokers (n = 232). Patients who smoked half a pack of cigarettes per day within the last 2 years were identified as smokers, and patients who did not smoke were included in the nonsmoker group. Patients with less than a seventh grade education; an inability to read; or a history of one of the following medical conditions: prior stroke with residual deficit, psychiatric illness, renal disease (creatinine > 2.0 mg/dL), or active liver disease; or patients who quit smoking prior to surgery were excluded from the study. Both groups received similar anesthetic and surgical management. All patients received a battery of neurocognitive tests both preoperatively and 6 weeks after CABG surgery. Neurocognitive test scores were separated into 4 cognitive domains, with a composite cognitive index (the mean of the four domain scores) determined for each patient at every testing period.
  
  
  RESULTS
  The overall rate of cognitive decline at 6 weeks after surgery in smokers was 36.2%, whereas nonsmokers showed a deficit rate of 36.6%. Nonsmokers were significantly older and presented for surgery on average 6 years later than the smokers. Female sex represented a considerably larger proportion of patients in the nonsmoker group. Smokers had a higher prevalence of myocardial infarction. The univariate analysis of cognitive change at 6 weeks adjusted for age, baseline cognitive index, and education years showed no difference between the 2 groups. Sex, history of myocardial infarction, hypertension, stroke, transient ischemic attack, and duration of cardiopulmonary bypass did not contribute to the multivariate logistic regression model and were dropped from the final analysis. Significant multivariate predictors of neurocognitive dysfunction included age, left ventricular ejection fraction, baseline education level, and baseline cognitive index.
  
  
  CONCLUSIONS
  This study confirmed previous findings that age, baseline cognitive function, years of education, and impaired left ventricular function are independent predictors of neurocognitive decline at 6 weeks after CABG surgery. Smoking is neither preventive nor causative of cognitive decline after CABG surgery.
authors.affiliation: Departments of Anesthesiology and Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
authors.forename: George N
authors.initials: GN
authors.lastname: Djaiani
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips-Bute
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Mark F
authors.initials: MF
authors.lastname: Newman
mesh_terms: D000368:Aged; D003071:Cognition / Q000187:drug effects*; D001026:Coronary Artery Bypass; D005260:Female; D005731:Ganglionic Stimulants / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D009538:Nicotine / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005731:Ganglionic Stimulants; D009538:Nicotine