Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities.
OBJECTIVE
The risk of stroke after coronary artery bypass grafting (CABG) is known to increase dramatically with age. During recent years, the age of patients operated on has increased and concomitant therapy has changed. Therefore, we have re-evaluated the risk of stroke after CABG.


METHODS
Through the Danish National Hospital Register, we identified all 25 159 patients with isolated CABG from 1997 through 2006. Stroke, comorbidities, and medication were further obtained. Risk factors of stroke were determined through regression models.


RESULTS
Overall, 1901 patients (7.6%) suffered a stroke after surgery, 477 patients (2.0%) within 30 days after CABG. Rates of stroke per 100 person-years (95% CI) within 30 days after surgery increased with age: <60 years, 10.1 (7.8-13.0); 60 to 64 years, 18.4 (14.3-23.5); 65 to 69 years, 27.7 (23.0-33.3); 70 to 74 years, 36.0 (30.4-42.6); 75 to 79 years, 36.1 (29.1-44.7); ≥80 years, 38.0 (25.2-57.1). Risks of stroke within 30 days after surgery adjusted for age (reference: age <60 years), sex, relevant comorbidities, and selected medication included: 60 to 64 years: HR, 1.7 (P=0.005; 95% CI, 1.2-2.4), 65 to 69 years: HR, 2.4 (P=0.001; 95% CI, 1.7-3.3), 70 to 74 years: HR, 2.8 (P=0.001; 95% CI, 2.1-3.8), 75 to 79 years: HR, 2.8 (P=0.001; 95% CI, 2.0-4.0), ≥80 years: HR, 3.0 (P=0.001; 95% CI, 1.8-4.9), previous stroke: HR, 4.2 (P=0.001; 95% CI, 3.3-5.4), diabetes: HR, 1.3 (P=0.019; 95% CI, 1.1-1.7), hypertension: HR, 1.4 (P=0.003; 95% CI, 1.1-1.7), peripheral vascular disease: HR, 1.6 (P=0.001; 95% CI, 1.3-2.1), renal failure: HR, 1.7 (P=0.012; 95% CI, 1.1-2.5), statins: HR, 0.8 (P=0.049; 95% CI, 0.7-1.0), clopidogrel: HR, 0.6 (P=0.032; 95% CI, 0.4-1.0).


CONCLUSIONS
The increase in stroke with age after CABG is moderate and the relation uncertain in ages older than 70 years. Declining CABG in elderly patients because of risk of stroke purely on the basis of high age is debatable.
Department of Cardiology, Copenhagen University Hospital, Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. c.merie@mail.dk
Charlotte
C
Mérie
Lars
L
Køber
Peter Skov
PS
Olsen
Charlotte
C
Andersson
Jan Skov
JS
Jensen
Christian
C
Torp-Pedersen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012306:Risk; D020521:Stroke / Q000209:etiology*