Temporal pattern of strokes after on-pump and off-pump coronary artery bypass graft surgery.
BACKGROUND
The incidence of strokes has not decreased after coronary artery bypass graft surgery (CABG). The purpose of this study is to identify incidence, risk factors, and temporal pattern of strokes after on-pump and off-pump CABG.


METHODS
We analyzed 2,516 consecutive patients who underwent first elective isolated CABG. The primary endpoint was strokes within 30 days. The temporal onset of the deficits was classified by consensus as either an "early stroke," which is present just after emergence from anesthesia, or a "delayed stroke," which is present after first awaking from surgery without a neurologic deficit.


RESULTS
More than half of strokes (29 of 46; 63%) were delayed strokes. Patients undergoing off-pump CABG had significantly lower risk of early stroke (0.1% versus 1.1%, p = 0.0009), whereas the incidence of delayed strokes was not different significantly (0.9% versus 1.4%, p = 0.3484) between patients undergoing on-pump and off-pump CABG. In multivariate analyses, undergoing off-pump CABG was an independent protective factor for all strokes (relative risk 0.29, 95% confidence interval: 0.14 to 0.56, p = 0.0005) and early strokes (relative risk 0.05, 95% confidence interval: 0.003 to 0.24, p < 0.0001), but it was not an independent protective factor for delayed strokes (relative risk 0.54, 95% confidence interval: 0.24 to 1.17, p = 0.1210).


CONCLUSIONS
Undergoing off-pump CABG reduces the incidence of perioperative stroke mainly by minimizing early strokes; however, the risk of delayed strokes is not different between patients undergoing on-pump and off-pump CABG.
Nishiyama
Kei
K
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. keinishi@kuhp.kyoto-u.ac.jp
Horiguchi
Masahito
M
Shizuta
Satoshi
S
Doi
Takahiro
T
Ehara
Natsuhiko
N
Tanuguchi
Ryoji
R
Haruna
Yoshizumi
Y
Nakagawa
Yoshihisa
Y
Furukawa
Yutaka
Y
Fukushima
Masanori
M
Kita
Toru
T
Kimura
Takeshi
T
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors