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Published in: Journal of Cardiothoracic Surgery 1/2011

Open Access 01-12-2011 | Research article

Risk Factors For Recurrent Stroke After Coronary Artery Bypass Grafting

Authors: Li Cao, Qin Li, Qi Bi, Qin-Jun Yu

Published in: Journal of Cardiothoracic Surgery | Issue 1/2011

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Abstract

Objectives

Preventing stroke after coronary artery bypass grafting (CABG) remains a therapeutic goal, due in part to the lack of identifiable risk factors. The aim of this study, accordingly, was to identify risk factors in CABG patients with a previous history of stroke.

Methods

Patients with a history of stroke who underwent CABG at Beijing An Zhen hospital from January 2007 to July 2010 were selected (n = 430), and divided into two groups according to the occurrence of postoperative stroke. Pre-operative and post-operative data were retrospectively collected and analyzed by univariate and multivariate logistic regression analyses.

Results

Thirty-two patients (7.4%) suffered post-operative stroke. Univariate analysis identified several statistically significant risk factors in the post-operative stroke group, including pre-surgical left ventricular ejection fractions (LVEF) ≤50%, on-pump surgery, post-operative atrial fibrillation (AF), and hypotension. Multivariable analysis identified 4 independent risk factors for recurrent stroke: unstable angina (odds ratio (OR) = 2.95, 95% CI: 1.05-8.28), LVEF ≤50% (OR = 2.77, 95% CI: 1.23-6.27), AF (OR = 4.69, 95% CI: 1.89-11.63), and hypotension (OR = 2.55, 95% CI: 1.07-6.04).

Conclusion

Unstable angina, LVEF ≤50%, post-operative AF, and post-operative hypotension are independent risk factors of recurrent stroke in CABG patients with a previous history of stroke.
Literature
1.
go back to reference Redmond JM, Greene PS, Goldsborough MA, Cameron DE, Stuart RS, Sussman MS, Watkins L, Laschinger JC, McKhann GM, Johnston MV, Baumgartner WA: Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg. 1996, 61: 42-7. 10.1016/0003-4975(95)00903-5.CrossRefPubMed Redmond JM, Greene PS, Goldsborough MA, Cameron DE, Stuart RS, Sussman MS, Watkins L, Laschinger JC, McKhann GM, Johnston MV, Baumgartner WA: Neurologic injury in cardiac surgical patients with a history of stroke. Ann Thorac Surg. 1996, 61: 42-7. 10.1016/0003-4975(95)00903-5.CrossRefPubMed
2.
go back to reference Stamou SC, Hill PC, Dangas G, Pfister AJ, Boyce SW, Dullum MK, Bafi AS, Corso PJ: Stroke after coronary artery bypass:incidence, predictors, and clinical outcome editorial comment: incidence, predictors, and clinical outcome. Stroke. 2001, 32: 1508-13. 10.1161/01.STR.32.7.1508.CrossRefPubMed Stamou SC, Hill PC, Dangas G, Pfister AJ, Boyce SW, Dullum MK, Bafi AS, Corso PJ: Stroke after coronary artery bypass:incidence, predictors, and clinical outcome editorial comment: incidence, predictors, and clinical outcome. Stroke. 2001, 32: 1508-13. 10.1161/01.STR.32.7.1508.CrossRefPubMed
3.
go back to reference Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Onnasch JF, Metz S, Falk V, Mohr FW: Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003, 75: 472-478. 10.1016/S0003-4975(02)04370-9.CrossRefPubMed Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Onnasch JF, Metz S, Falk V, Mohr FW: Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003, 75: 472-478. 10.1016/S0003-4975(02)04370-9.CrossRefPubMed
4.
go back to reference Noyez L, Van Swieten HA: Stroke after coronary artery bypass grafting. Is there place for a stroke-risk stratification model?. The Journal of Cardiovascular Surgery. 2009, 50: 63-69.PubMed Noyez L, Van Swieten HA: Stroke after coronary artery bypass grafting. Is there place for a stroke-risk stratification model?. The Journal of Cardiovascular Surgery. 2009, 50: 63-69.PubMed
5.
go back to reference Schwartz LB, Bridgman AH, Kieffer RW, Wilcox RA, McCann RL, Tawil MP, Scott SM: Asymptomatic carotid artery stenosis and stroke in patients undergoing cardiovascular bypass. J Vasc Surg. 1995, 21: 146-53. 10.1016/S0741-5214(95)70253-9.CrossRefPubMed Schwartz LB, Bridgman AH, Kieffer RW, Wilcox RA, McCann RL, Tawil MP, Scott SM: Asymptomatic carotid artery stenosis and stroke in patients undergoing cardiovascular bypass. J Vasc Surg. 1995, 21: 146-53. 10.1016/S0741-5214(95)70253-9.CrossRefPubMed
6.
go back to reference Das SK, Brow TD, Pepper J: Continuing controversy in the management of concomitant coronary and carotid disease: an overview. International Journal of Cardiology. 2000, 74: 47-65. 10.1016/S0167-5273(00)00251-5.CrossRefPubMed Das SK, Brow TD, Pepper J: Continuing controversy in the management of concomitant coronary and carotid disease: an overview. International Journal of Cardiology. 2000, 74: 47-65. 10.1016/S0167-5273(00)00251-5.CrossRefPubMed
7.
go back to reference Salasidis GC, Latter DA, Steinmetz OK, Blair JF, Graham AM: Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization. J Vasc Surg. 1995, 21: 154-61. 10.1016/S0741-5214(95)70254-7.CrossRefPubMed Salasidis GC, Latter DA, Steinmetz OK, Blair JF, Graham AM: Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization. J Vasc Surg. 1995, 21: 154-61. 10.1016/S0741-5214(95)70254-7.CrossRefPubMed
8.
go back to reference D'Agostino RS, Svensson LG, Neumann DJ, Balkhy HH, Williamson WA, Shahian DM: Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg. 1996, 62: 1714-23. 10.1016/S0003-4975(96)00885-5.CrossRefPubMed D'Agostino RS, Svensson LG, Neumann DJ, Balkhy HH, Williamson WA, Shahian DM: Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients. Ann Thorac Surg. 1996, 62: 1714-23. 10.1016/S0003-4975(96)00885-5.CrossRefPubMed
9.
go back to reference Schoof J, Lubahn W, Baeumer M, Kross R, Wallesch CW, Kozian A, Huth C, Goertler M: Impaired cerebral autoregulation distal to carotid stenosis/occlusion is associated with increased risk of stroke at cardiac surgery with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2007, 134: 690-6. 10.1016/j.jtcvs.2007.03.018.CrossRefPubMed Schoof J, Lubahn W, Baeumer M, Kross R, Wallesch CW, Kozian A, Huth C, Goertler M: Impaired cerebral autoregulation distal to carotid stenosis/occlusion is associated with increased risk of stroke at cardiac surgery with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2007, 134: 690-6. 10.1016/j.jtcvs.2007.03.018.CrossRefPubMed
10.
go back to reference Ogata J, Masuda J, Yutani C, Yamaguchi T: Mechanisms of cerebral artery thrombosis: a histopathological analysis on eight necropsy cases. J Neurol Neurosurg Psychiatry. 1994, 57: 17-21. 10.1136/jnnp.57.1.17.CrossRefPubMedPubMedCentral Ogata J, Masuda J, Yutani C, Yamaguchi T: Mechanisms of cerebral artery thrombosis: a histopathological analysis on eight necropsy cases. J Neurol Neurosurg Psychiatry. 1994, 57: 17-21. 10.1136/jnnp.57.1.17.CrossRefPubMedPubMedCentral
11.
go back to reference Peel GK, Stamou SC, Dullum MK, Hill PC, Jablonski KA, Bafi AS, Boyce SW, Petro KR, Corso PJ: Chronologic distribution of stroke after minimally invasive versus conventional coronary artery bypass. J Am Coll Cardiol. 2004, 43: 752-756. 10.1016/j.jacc.2003.09.047.CrossRefPubMed Peel GK, Stamou SC, Dullum MK, Hill PC, Jablonski KA, Bafi AS, Boyce SW, Petro KR, Corso PJ: Chronologic distribution of stroke after minimally invasive versus conventional coronary artery bypass. J Am Coll Cardiol. 2004, 43: 752-756. 10.1016/j.jacc.2003.09.047.CrossRefPubMed
12.
go back to reference Filsoufi F, Rahmanian PB, Castillo JG, Bronster D, Adams DH: Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2008, 85: 862-870. 10.1016/j.athoracsur.2007.10.060.CrossRefPubMed Filsoufi F, Rahmanian PB, Castillo JG, Bronster D, Adams DH: Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2008, 85: 862-870. 10.1016/j.athoracsur.2007.10.060.CrossRefPubMed
13.
go back to reference Ancona G, Saez de Ibarra JI, Baillot R: Determinants of stroke after coronary artery bypass grafting. Eur J Cardiothorac Surg. 2003, 24: 552-556. 10.1016/S1010-7940(03)00440-8.CrossRefPubMed Ancona G, Saez de Ibarra JI, Baillot R: Determinants of stroke after coronary artery bypass grafting. Eur J Cardiothorac Surg. 2003, 24: 552-556. 10.1016/S1010-7940(03)00440-8.CrossRefPubMed
14.
go back to reference Tadic M, Ivanovic B, Zivkovic N: Predictors of atrial fibrillation following coronary artery bypass surgery. Med Sci Monit. 2010, 17: 48-55. Tadic M, Ivanovic B, Zivkovic N: Predictors of atrial fibrillation following coronary artery bypass surgery. Med Sci Monit. 2010, 17: 48-55.
15.
go back to reference Choi YS, Shim JK, Hong SW, Kim DH, Kim JC, Kwak YL: Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement. Eur J Cardiothorac Surg. 2009, 36 (5): 838-43. 10.1016/j.ejcts.2009.05.003.CrossRefPubMed Choi YS, Shim JK, Hong SW, Kim DH, Kim JC, Kwak YL: Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement. Eur J Cardiothorac Surg. 2009, 36 (5): 838-43. 10.1016/j.ejcts.2009.05.003.CrossRefPubMed
16.
go back to reference Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, Lopez JA, Rasekh A, Wilson JM, Massumi Al: Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004, 43: 742-748. 10.1016/j.jacc.2003.11.023.CrossRefPubMed Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, Lopez JA, Rasekh A, Wilson JM, Massumi Al: Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004, 43: 742-748. 10.1016/j.jacc.2003.11.023.CrossRefPubMed
17.
go back to reference Kollar A, Lick SD, Vasquez KN, Conti VR: Relationship of atrial fibrillation and stroke after coronary artery bypass graft surgery: when is anticoagulation indicated?. Ann Thorac Surg. 2006, 82: 515-523. 10.1016/j.athoracsur.2006.03.037.CrossRefPubMed Kollar A, Lick SD, Vasquez KN, Conti VR: Relationship of atrial fibrillation and stroke after coronary artery bypass graft surgery: when is anticoagulation indicated?. Ann Thorac Surg. 2006, 82: 515-523. 10.1016/j.athoracsur.2006.03.037.CrossRefPubMed
18.
go back to reference Lahtinen J, Biancari F, Salmela E, Mosorin M, Satta J, Rainio P, Rimpiläinen J, Lepojärvi M, Juvonen T: Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg. 2004, 77: 1241-1244. 10.1016/j.athoracsur.2003.09.077.CrossRefPubMed Lahtinen J, Biancari F, Salmela E, Mosorin M, Satta J, Rainio P, Rimpiläinen J, Lepojärvi M, Juvonen T: Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg. 2004, 77: 1241-1244. 10.1016/j.athoracsur.2003.09.077.CrossRefPubMed
19.
go back to reference Gottesman RF, Sherman PM, Grega MA, Yousem DM, Borowicz LM, Selnes OA, Baumgartner WA, McKhann GM: Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome, Stroke. 2006, 37: 2306-2311. Gottesman RF, Sherman PM, Grega MA, Yousem DM, Borowicz LM, Selnes OA, Baumgartner WA, McKhann GM: Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome, Stroke. 2006, 37: 2306-2311.
20.
go back to reference Gao Peiyi: CT perfusion imaging and stages of regional cerebral hypoperfusion in pre-infarction period. Chin J Stroke. 2008, 3: 115-119. Gao Peiyi: CT perfusion imaging and stages of regional cerebral hypoperfusion in pre-infarction period. Chin J Stroke. 2008, 3: 115-119.
21.
go back to reference Ohuchi S, Kawazoe K, Izumoto H, Yoshioka K: Magnetic resonance angiography in coronary artery bypass grafting. Asian Cardiovasc Thorac Ann. 2006, 14: 43-6.CrossRefPubMed Ohuchi S, Kawazoe K, Izumoto H, Yoshioka K: Magnetic resonance angiography in coronary artery bypass grafting. Asian Cardiovasc Thorac Ann. 2006, 14: 43-6.CrossRefPubMed
22.
go back to reference Kiyoshi Doi, Hitoshi Yaku: Importance of cerebral artery risk evaluation before off-pump coronary artery bypass grafting to avoid perioperative stroke. European Journal of Cardio-thoracic Surgery. 2010, 38: 568-572. 10.1016/j.ejcts.2010.03.021.CrossRef Kiyoshi Doi, Hitoshi Yaku: Importance of cerebral artery risk evaluation before off-pump coronary artery bypass grafting to avoid perioperative stroke. European Journal of Cardio-thoracic Surgery. 2010, 38: 568-572. 10.1016/j.ejcts.2010.03.021.CrossRef
Metadata
Title
Risk Factors For Recurrent Stroke After Coronary Artery Bypass Grafting
Authors
Li Cao
Qin Li
Qi Bi
Qin-Jun Yu
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2011
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/1749-8090-6-157

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