title: Atherosclerosis is associated with delirium after coronary artery bypass graft surgery.
abstract: 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.
authors.affiliation: Geriatric Research, Education, and Clinical Center, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA. jrudolph@partners.org
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
authors.forename: Viken L
authors.initials: VL
authors.lastname: Babikian
authors.forename: Vladimir
authors.initials: V
authors.lastname: Birjiniuk
authors.forename: Michael D
authors.initials: MD
authors.lastname: Crittenden
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Treanor
authors.forename: Val E
authors.initials: VE
authors.lastname: Pochay
authors.forename: Shukri F
authors.initials: SF
authors.lastname: Khuri
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: 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