title: Impact of preexisting cerebral ischemia detected by magnetic resonance imaging and angiography on late outcome after coronary artery bypass surgery.
abstract: BACKGROUND
  The aim of this study was to assess the impact of preexisting ischemia detected by brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) on long-term survival, and cardiac and neurologic events after coronary artery bypass grafting (CABG).
  
  
  METHODS
  Of 923 patients who underwent CABG between 1994 and 2007, 887 patients (96.1%) were followed up. Preoperative brain MRI and MRA were performed in 619 patients. Ischemia was detected by brain MRI and MRA in 158 patients (group A), but not in 461 patients (group B). Preoperative characteristics, follow-up survival, and cardiac and neurological events were investigated.
  
  
  RESULTS
  The average follow-up period was 6.0 ± 4.3 years. Univariate analysis showed that patients in group A (68.5 ± 6.5 years) were older than those in group B (64.5 ± 8.6 years) (p = 0.0001). Preoperative left ventricular ejection fraction was less in group A (0.516 ± 0.175) than in group B (0.556 ± 0.165) (p = 0.02). The prevalence of peripheral vascular disease was higher in group A (14 patients: 8.9%) than in group B (11 patients: 2.4%) (p = 0.001). The rate of on-pump CABG was lower in group A (115 patients; 72.8%) than in group B (383 patients; 83.1%) (p = 0.007). Survival rate was significantly lower (p = 0.062), and freedom from major adverse cardiac event or stroke were significantly lower in group A (p = 0.0002, and p = 0.0001, respectively; log-rank test). However, the Cox proportional hazard model showed that preoperative brain ischemia detected by brain MRI and MRA affected only freedom from neurologic events (p = 0.02; hazard ratio 2.52; 95% confidence interval 1.13 to 5.62), but not survival (p = 0.67) or major adverse cardiac event (p = 0.09).
  
  
  CONCLUSIONS
  Preexisting ischemic findings on brain MRI and MRA in patients who underwent CABG were related only to long-term freedom from stroke, but were not related to survival or major adverse cardiac event.
authors.affiliation: Department of Cardiovascular Surgery, Funabashi Municipal Medical Center, Chiba, Japan. km4717jp@yahoo.co.jp
authors.forename: Kaoru
authors.initials: K
authors.lastname: Matsuura
authors.forename: Kenji
authors.initials: K
authors.lastname: Mogi
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakurai
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kawamura
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Takahara
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D001026:Coronary Artery Bypass; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome