Atherosclerosis is associated with delirium after coronary artery bypass graft surgery.
OBJECTIVE
To investigate whether atherosclerosis of the ascending aorta, internal carotid arteries, and coronary arteries is predictive of postoperative delirium in subjects undergoing coronary artery bypass graft (CABG) surgery.


METHODS
Prospective cohort study.


METHODS
Boston Veterans Affairs Healthcare System.


METHODS
Thirty-six male veterans undergoing primary CABG surgery.


METHODS
Subjects underwent Duplex ultrasound to assess stenosis in the internal carotid arteries. Information on the ascending aortic plaque, as assessed by transesophageal echocardiogram, and the number of coronary vessels bypassed was collected. To create an atherosclerosis score, the number of atherosclerotic areas was added. A validated delirium battery was administered to the subjects preoperatively and on postoperative Days 2 and 5.


RESULTS
Fifteen subjects (41.7%) developed delirium postoperatively. In bivariate analysis, carotid stenosis of 50% or more (relative risk (RR)=3.5, 95% confidence interval (CI)=1.5-8.1) and moderate-severe ascending aortic plaque (RR=2.9, 95% CI=1.0-8.5) were significantly associated with the development of delirium. There was a trend toward a significant association for three or more vessels bypassed (RR=9.6, 95% CI=0.6-145.3). After controlling for age, baseline cognition, and medical comorbidity, the atherosclerosis score was significantly associated with postoperative delirium (adjusted RR=2.7, 95% CI=1.1-6.8).


CONCLUSIONS
In this preliminary report, atherosclerosis in the carotid arteries, aorta, and coronary circulation is associated with the development of delirium after CABG surgery. Further investigation into atherosclerosis as a risk factor for delirium is warranted.
Rudolph
James L
JL
Geriatric Research, Education, and Clinical Center, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA. jrudolph@partners.org
Babikian
Viken L
VL
Birjiniuk
Vladimir
V
Crittenden
Michael D
MD
Treanor
Patrick R
PR
Pochay
Val E
VE
Khuri
Shukri F
SF
Marcantonio
Edward R
ER
D000368:Aged; D001161:Arteriosclerosis / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003693:Delirium / Q000209:etiology*; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography