Carotid Artery Disease as a Predictor of In-Hospital Postoperative Stroke After Coronary Artery Bypass Grafting From 1999 to 2011

Abstract

In this study, the risk factors for stroke after coronary artery bypass grafting (CABG) were examined. In particular, the role of asymptomatic carotid artery stenosis (both unilateral and bilateral) as a predictor of in-hospital postoperative stroke was investigated. Finally, the trends surrounding in-hospital postoperative stroke from 1999 to 2011 also were examined. The purpose of the study was to appropriately identify patients at high risk for stroke after CABG and spark discussion about the perioperative management of such patients. Data from the Nationwide Inpatient Sample from 1999 to 2011 were analyzed retrospectively. The study cohort was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification and Projection Clinical Classification Software codes. Exploratory statistics, univariate analyses, and multivariable regression were used for this study. The analysis demonstrated that both asymptomatic unilateral and bilateral carotid stenoses were independent risk factors for in-hospital postoperative stroke. In addition, increasing age, female sex, increasing van Walraven score, paralysis, neurologic disorders, history of infective endocarditis, asymptomatic basilar stenosis, and cerebral occlusion all were demonstrated to be statistically significant predictors of stroke. Patients with carotid stenosis and a van Walraven score >14 were found to be particularly vulnerable to in-hospital postoperative stroke. Lastly, predictors of carotid stenosis were examined, and increasing age, female sex, and increasing van Walraven score all were found to be significant predictors of asymptomatic carotid stenosis. This study examined risk factors for stroke after CABG in a large, longitudinal, and population-based database. The study found that both unilateral and bilateral asymptomatic carotid stenoses are indeed risk factors for in-hospital postoperative stroke. In addition, a number of other predictors were identified. These results can be used to identify patients at high risk for perioperative stroke and hopefully decrease the rate of a devastating complication of CABG.