Impact of preoperative neurologic events on outcomes after coronary artery bypass grafting.
BACKGROUND
Neurologic events (permanent stroke and transient events) can be devastating complications after coronary artery bypass grafting (CABG). This study assessed the impact of a history of preoperative neurologic events on postoperative outcomes in patients undergoing off-pump coronary artery bypass (OPCAB) vs conventional coronary artery bypass (CCAB).


METHODS
From January 1996 to June 2006, 14,278 patients underwent primary, isolated CABG (5641 OPCAB and 8637 CCAB) at Emory Healthcare Hospitals and were prospectively entered into a computerized database. In a multiple logistic regression analysis using propensity score adjustment, we evaluated the impact of preoperative neurologic events on in-hospital mortality and postoperative neurologic events in patients undergoing OPCAB vs CCAB using adjusted odds ratios (AOR).


RESULTS
Overall, postoperative neurologic events occurred in 1.9% (274 of 14,278) of patients and were associated with an in-hospital mortality of 13.5% (37 of 274). In the logistic regression analysis, patients with preoperative neurologic events had a higher incidence of postoperative neurologic events (AOR, 3.07; p < 0.0001) and in-hospital mortality (AOR, 2.19; p < 0.0001). The OPCAB patients were less likely to have postoperative neurologic events compared with CCAB patients (AOR, 0.49; p < 0.001). However, no significant interaction existed between preoperative neurologic events and operation type for any of the postoperative comparisons.


CONCLUSIONS
Preoperative neurologic events are risk factors for postoperative neurologic events and in-hospital mortality. OPCAB is associated with a reduced risk of postoperative neurologic events compared with CCAB. However, OPCAB does not confer additional risk reduction in patients with preoperative neurologic events.
Halkos
Michael E
ME
Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30308, USA.
Puskas
John D
JD
Lattouf
Omar M
OM
Kilgo
Patrick
P
Guyton
Robert A
RA
Thourani
Vinod H
VH
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D016019:Survival Analysis; D016896:Treatment Outcome