title: Mildly reduced preoperative ejection fraction increases the risk of stroke in older adults undergoing coronary artery bypass grafting.
abstract: BACKGROUND
  Current guidelines based on clinical trials may have inadvertently excluded a representative cohort of older adults. As a result, little is known about the predictors of stroke among elderly patients undergoing coronary artery bypass surgery (CABG). The purpose of this study was to determine how a lower than normal ejection fraction (EF) predicted post surgery stroke among elderly patients undergoing CABG when compared with younger populations.
  
  
  METHODS
  Retrospective cross-sectional cohort analysis. setting: Charleston Area Medical Center, a tertiary medical center.
  
  
  METHODS
  8661 consecutive CABG cases between 2003 and 2009. measurements: PARTICIPANTS were divided into three different age groups: < 65 years old (Group 1), between 65 and 79 years old (Group 2), and > or = 80 years old (Group 3). We calculated the rate of overall neurological complications after CABG for patients with ejection fraction values: < 40%, between 40% and 59%, and > or = 60.
  
  
  RESULTS
  Group 3 (age > = 80) with EF < = 39 had the highest odds of developing post CABG stroke (Odds Ratio (OR): 5.6) followed by Group 3 (age > = 80) with EF 40-59 (OR: 3.9). In addition, Group 2 (age 65-79) with EF < = 39 had the next highest odds of developing post CABG stroke (OR: 2.3) followed by Group 2 (age 65-79) with EF 40-59 (OR: 1.9).
  
  
  CONCLUSIONS
  Contrary to current guidelines, in our study population, mildly affected EF increased the overall risk of neurological complications among elderly patients undergoing CABG.
authors.affiliation: Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, West Virginia, USA.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Reyes
authors.forename: Chase
authors.initials: C
authors.lastname: Trotter
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ladd
authors.forename: Mike
authors.initials: M
authors.lastname: Broce
authors.forename: Maher
authors.initials: M
authors.lastname: Kali
authors.forename: Samuel
authors.initials: S
authors.lastname: Groves
authors.forename: Donald
authors.initials: D
authors.lastname: Lilly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left; D014903:West Virginia / Q000453:epidemiology