Impact of Covert Brain Infarction Following Coronary Angiography on Coronary Artery Bypass Surgery Outcomes

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ObjectiveTo determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCE) after CABG. DesignCohort study between January 2006 and December 2019 with the follow-up period concluding at either 5 years after surgery, the date of death, or April 27th, 2023. SettingAt a single tertiary center in Korea. ParticipantsPatients who underwent pre-operative CAG and subsequent brain magnetic resonance imaging (MRI) before elective CABG. InterventionsNone. Measurements and Main ResultsThe primary outcome was the incidence of MACCE within 30 days of CABG. MACCE included operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. The secondary outcomes included each component of MACCE and all-cause mortality at 5 years after surgery. Out of the 2,476 study patients (median [IQR] age, 65 [58 to 71] years; 24.7% were female), 212 (8.6%) had covert cerebral infarction on brain MRI after CAG but before CABG, and 353 (14.3%) patients experienced MACCE after CABG. After performing 1:4 propensity-score matching, a total of 1,057 patients were included in the final outcome analysis (212 with covert brain infarction and 845 without). The incidence of MACCE within 30 days was not significantly different between patients with a covert brain infarction and those without (15.1% [32/212] vs. 15.6% [132/845]; risk difference, -0.5, 95% confidence interval [CI]: -5.6 to 4.4; risk ratio: 0.97, 95% CI, 0.66 to 1.32; P=.85). There were also no significant differences in each component of MACCE within 30 days. There was no significant difference between the two groups in terms of all-cause mortality at 5 years (18.7% vs. 17.0%, respectively, P for stratified log-rank test=.33). ConclusionsAmong patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCE within 30 days and long-term mortality after CABG.