Incidence and Predictors of TIAs and Strokes Following Coronary Artery Bypass Grafting: Report and Collective Review

(#1999-0933 ... June 18, 1999)

Daniel T. Engelman, MD, Lawrence H. Cohn, MD, Robert J. Rizzo, MD

Brigham & Women's Hospital, Boston, MA, USA

ABSTRACT

Background: Neurologic complications account for some of the most devastating problems following coronary artery bypass surgery. In this study we determined the incidence and predictors of perioperative transient ischemic attacks (TIAs) and strokes in patients undergoing coronary artery bypass grafting at our institution.

Methods: Data was prospectively collected from 4,518 consecutive patients undergoing isolated coronary artery bypass grafting at Brigham & Women's Hospital between 1993 and 1997.

Results: One hundred and twenty of the 4,518 patients sustained either a TIA (30 patients, 0.7%) or a stroke (90 patients, 2.0%), for an overall incidence of 2.7%. Significant univariate predictors of TIA/stroke included a history of : 1) cerebral vascular disease, 2) peripheral vascular disease, 3) diabetes, 4) renal failure, 5) preoperative myocardial infarction, 6) hypertension, and 7) age > 70 years. Multivariate logistic regression analysis revealed the following significant associations (incidence of TIA/stroke, odds ratio): 1) cerebral vascular disease (6.4%, OR 2.5); 2) peripheral vascular disease (5.3%, OR 1.6); 3) renal failure (5.6%, OR 1.6); 4) myocardial infarction (3.2%, OR 1.5); 5) diabetes (3.7%, OR 1.5); 6) age > 70 (3.5%, OR 1.5). Perioperative TIA/stroke was significantly associated with postoperative low cardiac output and atrial fibrillation. Patients with TIA/stroke had a significantly longer ICU stay (4 vs. 2 median days), length of hospitalization (14 vs. 7 median days), and higher mortality rate (22% vs. 2.6%).

Conclusions: Perioperative TIA/stroke occurred in less than 3% of patients following coronary artery bypass grafting but was associated with significant mortality. The strongest predictors were cerebral and peripheral vascular disease.

AUTHOR/ARTICLE INFORMATION

Presented at the Conference on Cardiac and Vascular Surgery: Neurobehavioral Assessment, Physiological Monitoring and Cerebral Protective Strategies, Key West, Florida, May 27-31, 1998.

Reprint requests to: Dr. Robert J. Rizzo, Division of Cardiothoracic Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, Phone: 617-732-7678, Fax: 617-732-6559, Email: rjrizzo@bics.bwh.harvard.edu

Submitted on: June 15, 1999; Accepted on: June 18, 1999

Keywords: stroke, transient ischemic attacks (TIA), coronary artery bypass, CABG