Abstract
IntroductionThe aim of this study was to determine the outcomes of patients developing ischemic stroke after coronary artery bypass grafting (CABG).MethodsFrom March 2012 to January 2017, 5380 consecutive patients undergoing elective coronary surgery were analyzed. Ninety-five patients who developed ischemic strokes after on-pump coronary surgery were included in the study, retrospectively. The cohort was divided into four subgroups [total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), and lacunar infarction (LACI)] according to the Oxfordshire Community Stroke Project (OCSP) classification. The primary endpoints were in-hospital mortality, total mortality, and survival analysis over an average of 30 months of follow-up. The secondary endpoints were the extent of disability and dependency according to modified Rankin Scale (mRS).ResultsThe incidence of stroke was 1.76% (n=95). The median age was 62.03±10.06 years and 68 (71.6%) patients were male. The groups were as follows: TACI (n=17, 17.9%), PACI (n=47, 49.5%), POCI (n=20, 21.1%), and LACI (n=11, 11.6%). Twenty-eight (29.5%) patients died in hospital and 34 (35.8%) deaths occurred. The overall mortality rate of the TACI group was significantly higher than that of the LACI group (64.7% vs. 27.3%, P=0.041). The mean mRS score of the TACI group was significantly higher than that of the other groups (P=0.003).ConclusionPatients in the TACI group had higher in-hospital and cumulative mortality rates and higher mRS scores. We believe that use of the OCSP classification and the mRS may render it possible to predict the outcomes of stroke after coronary surgery.
Highlights
The aim of this study was to determine the outcomes of patients developing ischemic stroke after coronary artery bypass grafting (CABG)
The aim of this study was to explore the outcomes of ischemic stroke after coronary surgery by Oxfordshire Community Stroke Project (OCSP) subtype; we measured in-hospital and long-term survival, and stroke disability and dependence scores employing the modified Rankin Scale, which is widely used worldwide to assess stroke outcomes[12]
The cohort was divided into four subgroups (TACI, partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), and lacunar infarction (LACI)) by the subtype of ischemic stroke using the OCSP classification
Summary
The aim of this study was to determine the outcomes of patients developing ischemic stroke after coronary artery bypass grafting (CABG). Stroke is a devastating complication of coronary bypass surgery, significantly increasing mortality, morbidity, cost, and the need for long-term care, and reducing the quality of life. The incidence of stroke after cardiac surgery has ranged from 0.414% in different series[1,2] and varied by the type of surgery, with concomitant and valvular procedures being associated with the greatest risks[3]. The incidence of stroke after coronary surgery has been reported to be as low as 1-5% in some previous studies[4,5]. Three different mechanisms may be in play when postoperative stroke develops after cardiac surgical intervention: a brain perfusion disorder, an embolic event, and/or an inflammatory.
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