Risk factors for late stroke after coronary artery bypass grafting.
BACKGROUND
Postoperative stroke is a severe complication immediately after coronary artery bypass grafting, and it significantly deteriorates the postoperative quality of life if it occurs in the long term. It was the aim of our study to determine factors associated with the occurrence of new strokes during long-term follow-up after coronary artery bypass grafting.


METHODS
From 387 of 500 patients undergoing coronary artery bypass grafting (age, 67 years [33-84 years]; 76% male) who had intraoperative epiaortic ultrasonography for assessment of ascending aortic wall thickness, a complete follow-up regarding postoperative stroke was achieved. The median follow-up time was 52 months (9-74 months).


RESULTS
A stroke occurred in 26 (7%) of 387 patients, and the cumulative freedom from stroke was 99%, 95%, and 89% after 1, 3, and 5 years, respectively. A significantly lower freedom from stroke was present in patients with an age of 70 years or more (P = .007), preoperative unstable angina (P = .031), chronic obstructive pulmonary disease (P = .009), carotid artery disease (P < .001), preoperative history of neurologic events (P < .001), and a maximum ascending aortic wall thickness of 4 mm or more (P = .010). Multivariate analysis revealed preoperative history of neurologic events (P = .021) to be an independent risk factor.


CONCLUSIONS
Patients with ascending aortic atherosclerosis, older age (> or =70 years), preoperative unstable angina, chronic obstructive pulmonary disease, and carotid artery disease are at risk for late postoperative stroke after coronary artery bypass grafting. A history of neurologic events is of special predictive importance.
Schachner
Thomas
T
Department of Cardiac Surgery, Insbruck Medical University, Austria. Thomas.Schachner@uibk.ac.at
Zimmer
Anne
A
Nagele
Georg
G
Laufer
Guenther
G
Bonatti
Johannes
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D001161:Arteriosclerosis / Q000150:complications* / Q000601:surgery; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D016896:Treatment Outcome; D014463:Ultrasonography