Predictive factors of stroke in patients undergoing coronary bypass grafting: statins are protective.
BACKGROUND
Despite major improvement in surgical techniques and intensive care management, stroke remains one of the most devastating complications of coronary artery bypass grafting (CABG). We aimed to determine factors predicting the occurrence of stroke during CABG. A special interest was focused on preoperative therapies.


METHODS
We prospectively enrolled 810 consecutive candidates for CABG alone in a specific database, including all pre- and perioperative data (history, clinical, therapeutic, cardiac catheterization, surgical and intensive care data). Univariate tests and then multiple logistic regression analysis were used to determine independent predictive factors.


RESULTS
During the first postoperative month, stroke occurred in 11 cases and transient ischemic attack (TIA) in 4 additive cases (cumulative rate: 1.85%). After the multivariate analysis, the following factors remained significant (p<0.05) in the predictive model, with corresponding odds ratios between brackets: redo cardiac surgery (7.45), unstable cardiac status (4.74), past history of cerebrovascular disease (4.14), past history of peripheral arterial disease (3.55), whereas the presence of preoperative statins was protective (0.24, 95% IC: 0.07-0.78). The addition of perioperative data (aortic calcification, postoperative arrhythmia, on/off-pump surgery) did not change the final predictive model.


CONCLUSIONS
To our knowledge, this is the first real-world observational report highlighting the interest of statins for the prevention of stroke in the very special situation of CABG. Even though according to randomized trials coronary patients have a benefit from these drugs, a special level of interest should be directed towards those presenting the above-mentioned risk factors.
Aboyans
Victor
V
Department of Thoracic & Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, 2, Ave. Martin Luther King, 87042 Limoges, France. victor.aboyans@unilim.fr
Labrousse
Louis
L
Lacroix
Philippe
P
Guilloux
Jérôme
J
Sekkal
Seifeddine
S
Le Guyader
Alexandre
A
Cornu
Elisabeth
E
Laskar
Marc
M
D000368:Aged; D002315:Cardiopulmonary Bypass; D002561:Cerebrovascular Disorders / Q000150:complications; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications; D012086:Reoperation / Q000009:adverse effects; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors