title: Preoperative hematocrit concentration and the risk of stroke in patients undergoing isolated coronary-artery bypass grafting.
abstract: Background. Identification and management of risk factors for stroke following isolated coronary artery bypass grafting (CABG) could potentially lower the risk of such serious morbidity. Methods. We retrieved data for 30-day stroke incidence and perioperative variables for patients undergoing isolated CABG and used multivariate logistic regression to assess the adjusted effect of preoperative hematocrit concentration on stroke incidence. Results. In 2,313 patients (mean age 65.9 years, 73.6% men), 43 (1.9%, 95% CI: 1.4-2.5) developed stroke within 30 days following CABG (74.4% within 6 days). After adjustment for a priori defined potential confounders, each 1% drop in preoperative hematocrit concentration was associated with 1.07 (95% CI: 1.01-1.13) increased odds for stroke (men, OR: 1.08, 95% CI: 1.01-1.16; women, OR: 1.02, 95% CI: 0.91-1.16). The predicted probability of stroke for descending preoperative hematocrit concentration exceeded 2% for values <37% (<37% for men (adjusted OR: 2.39, 95% CI: 1.08-5.26) and <38% for women (adjusted OR: 2.52, 95% CI: 0.53-11.98), with a steeper probability increase noted in men). The association between lower preoperative hematocrit concentration and stroke was evident irrespective of intraoperative transfusion use. Conclusion. Screening and management of patients with low preoperative hematocrit concentration may alter postoperative stroke risk in patients undergoing isolated CABG.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut 1107 2020, Lebanon ; Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, University of Milan, 20122 Milan, Italy.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Musallam
authors.forename: Faek R
authors.initials: FR
authors.lastname: Jamali
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: Toby
authors.initials: T
authors.lastname: Richards
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Kaivan
authors.initials: K
authors.lastname: Khavandi
authors.forename: Iskandar
authors.initials: I
authors.lastname: Barakat
authors.forename: Benjamin
authors.initials: B
authors.lastname: Demoss
authors.forename: Luca A
authors.initials: LA
authors.lastname: Lotta
authors.forename: Flora
authors.initials: F
authors.lastname: Peyvandi
authors.forename: Pier M
authors.initials: PM
authors.lastname: Sfeir