title: Predictors associated with stroke after coronary artery bypass grafting: a systematic review.
abstract: BACKGROUND
  Stroke is a major cause of morbidity and mortality after coronary artery bypass grafting (CABG). The purpose of this systematic review was to evaluate the predictors of perioperative stroke after CABG.
  
  
  METHODS
  We reviewed the published literature on prognostic factors for perioperative stroke after CABG in articles using multivariate regression models. The statistical validity of prognostic models and a qualitative synthesis were performed.
  
  
  RESULTS
  We identified 14 studies. The methodological quality of study reporting was variable. Overall, the incidence of stroke after CABG was 1.1-5.7%. About 37-59% of strokes occurred early (intraoperatively). No validated stroke outcome scale was used to assess morbidity and mortality in any of the included studies. Advanced age, prior (before CABG) cerebrovascular disease/stroke, prior carotid artery stenosis, prior peripheral vascular disease, prior unstable angina, and prolonged cardiopulmonary bypass time were found to be the most consistent independent predictors of perioperative stroke after CABG. Postoperative atrial fibrillations were found to be the most consistent independent variables associated with postoperative stroke after CABG. No association was found with hypercholesterolemia, prior myocardial infarct, and smoking. Other risk factors, such as gender, prior hypertension, diabetes mellitus, congestive heart failure, and chronic renal failure, showed inconsistent results.
  
  
  CONCLUSIONS
  Seven variables (advanced age, prior cerebrovascular disease/stroke, prior carotid artery stenosis, prior peripheral vascular disease, prior unstable angina, prolonged cardiopulmonary bypass time, and postoperative atrial fibrillation), representing and high atherosclerotic burden, were found to be associated with more perioperative stroke events. Stroke assessment scales should be included to enable a detailed description of stroke morbidity post CABG. Lessons learned from the present study should also help to improve the quality and relevance of future studies on prognostic factors in stroke after CABG.
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
authors.forename: Zhifeng
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Yin
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China. Electronic address: huxueqiangzssy@qq.com.
authors.forename: Xueqiang
authors.initials: X
authors.lastname: Hu
authors.affiliation: The George Institute for Global Health, The University of Sydney, Australia; School of Health, The University of Central Lancashire, Preston, United Kingdom.
authors.forename: Maree L
authors.initials: ML
authors.lastname: Hackett
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*
keywords: Atherosclerosis; Coronary artery bypass; Heart surgery; Prognosis; Stroke; Systematic review