Neurocognitive outcomes are not improved by 17beta-estradiol in postmenopausal women undergoing cardiac surgery.
OBJECTIVE
Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17beta-Estradiol limits the extent of ischemic neuronal injury in a variety of experimental models. The purpose of this study was to evaluate whether perioperative administration of 17beta-estradiol to postmenopausal women reduces the frequency of neurocognitive dysfunction after cardiac surgery.


METHODS
One hundred seventy-four postmenopausal women not on estrogen replacement therapy who were undergoing primary coronary artery bypass graft surgery and/or valve surgery with cardiopulmonary bypass were prospectively randomized to receive in a double-blinded manner either 17beta-estradiol or placebo beginning the day before surgery and continuing for 5 days postoperatively. The patients were evaluated before and after surgery with the National Institutes of Health Stroke Scale and a psychometric test battery.


RESULTS
There were no differences in the frequency of neurocognitive dysfunction (primary outcome) between patients randomized to perioperative 17beta-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17beta-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17beta-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions.


CONCLUSIONS
Perioperative treatment with 17beta-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.
Hogue
Charles W
CW
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA. chogue2@jhmi.edu
Freedland
Kenneth
K
Hershey
Tamara
T
Fucetola
Robert
R
Nassief
Abullah
A
Barzilai
Benico
B
Thomas
Betsy
B
Birge
Stanley
S
Dixon
David
D
Schechtman
Kenneth B
KB
Dávila-Román
Victor G
VG
D002545:Brain Ischemia / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D004958:Estradiol / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017698:Postmenopause; D016896:Treatment Outcome
D004958:Estradiol