Highlights
- •We reviewed 14 studies on prognostic factors for perioperative stroke after CABG.
- •Seven variables representing and high atherosclerotic burden were found to be associated with more perioperative stroke events.
- •Stroke assessment scales should be included to enable a detailed description of stroke morbidity post CABG.
Abstract
Background
Stroke is a major cause of morbidity and mortality after coronary artery bypass grafting
(CABG). The purpose of this systematic review was to evaluate the predictors of perioperative
stroke after CABG.
Methods
We reviewed the published literature on prognostic factors for perioperative stroke
after CABG in articles using multivariate regression models. The statistical validity
of prognostic models and a qualitative synthesis were performed.
Results
We identified 14 studies. The methodological quality of study reporting was variable.
Overall, the incidence of stroke after CABG was 1.1–5.7%. About 37–59% of strokes
occurred early (intraoperatively). No validated stroke outcome scale was used to assess
morbidity and mortality in any of the included studies. Advanced age, prior (before
CABG) cerebrovascular disease/stroke, prior carotid artery stenosis, prior peripheral
vascular disease, prior unstable angina, and prolonged cardiopulmonary bypass time
were found to be the most consistent independent predictors of perioperative stroke
after CABG. Postoperative atrial fibrillations were found to be the most consistent
independent variables associated with postoperative stroke after CABG. No association
was found with hypercholesterolemia, prior myocardial infarct, and smoking. Other
risk factors, such as gender, prior hypertension, diabetes mellitus, congestive heart
failure, and chronic renal failure, showed inconsistent results.
Conclusions
Seven variables (advanced age, prior cerebrovascular disease/stroke, prior carotid
artery stenosis, prior peripheral vascular disease, prior unstable angina, prolonged
cardiopulmonary bypass time, and postoperative atrial fibrillation), representing
and high atherosclerotic burden, were found to be associated with more perioperative
stroke events. Stroke assessment scales should be included to enable a detailed description
of stroke morbidity post CABG. Lessons learned from the present study should also
help to improve the quality and relevance of future studies on prognostic factors
in stroke after CABG.
Keywords
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References
- Early and delayed stroke after coronary surgery — an analysis of risk factors and the impact on short- and long-term survival.Eur. J. Cardiothorac. Surg. 2011; 40: 379-387
- Perioperative stroke and long-term survival after coronary bypass graft surgery.Ann. Thorac. Surg. 2005; 79 (discussion 537): 532-536
- Stroke after coronary artery bypass: incidence, predictors, and clinical outcome.Stroke. 2001; 32: 1508-1513
- Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis.J. Am. Coll. Cardiol. 2011; 57: 1811-1818
- Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting.Ann. Thorac. Surg. 2000; 69 (discussion 35–36): 30-35
- Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature.Eur. J. Vasc. Endovasc. Surg. 2002; 23: 283-294
- Cognitive and neurologic outcomes after coronary-artery bypass surgery.N. Engl. J. Med. 2012; 366: 250-257
- Perioperative stroke: risk assessment, prevention and treatment.Curr. Treat Options Cardiovasc. Med. 2014; 16: 282
- Determinants of stroke after coronary artery bypass grafting.Eur. J. Cardiothorac. Surg. 2003; 24: 552-556
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- Systematic review of prognostic models in patients with acute stroke.Cerebrovasc. Dis. 2001; 12: 159-170
- Early prediction of outcome of activities of daily living after stroke: a systematic review.Stroke. 2011; 42: 1482-1488
- Systematic reviews of evaluations of prognostic variables.BMJ. 2001; 323: 224-228
- 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2011; 124: 2610-2642
- Temporal pattern of strokes after on-pump and off-pump coronary artery bypass graft surgery.Ann. Thorac. Surg. 2009; 87: 1839-1844
- Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting.JAMA. 2011; 305: 381-390
- Predictors of depression after stroke: a systematic review of observational studies.Stroke. 2005; 36: 2296-2301
- Predictors of mortality in chronic Chagas disease: a systematic review of observational studies.Circulation. 2007; 115: 1101-1108
- Prognostic factors of remission in myasthenia gravis after thymectomy.Eur. J. Cardiothorac. Surg. 2015; 48: 18-24
- Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study.Ann. Thorac. Surg. 2002; 74: 474-480
- Stroke during coronary bypass surgery: principal role of cerebral macroemboli.Eur. J. Cardiothorac. Surg. 2001; 19: 627-632
- Screening carotid ultrasonography and risk factors for stroke in coronary artery surgery patients.Ann. Thorac. Surg. 1996; 62: 1714-1723
- Incidence and predictors of tias and strokes following coronary artery bypass grafting: report and collective review.Heart Surg. Forum. 1999; 2: 242-245
- Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting.Ann. Thorac. Surg. 2008; 85: 862-870
- Predictors of stroke risk in coronary artery bypass patients.Ann. Thorac. Surg. 1997; 63: 516-521
- Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities.Stroke. 2012; 43: 38-43
- Risk factors for stroke after coronary artery bypass grafting.Arq. Bras. Cardiol. 2008; 91: 213-216
- Kappa coefficients in medical research.Stat. Med. 2002; 21: 2109-2129
- Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale.Arch. Phys. Med. Rehabil. 2003; 84: 950-963
- Genetic polymorphisms and the risk of stroke after cardiac surgery.Stroke. 2005; 36: 1854-1858
- Study design validation for consolidating global with focal neurological events in cardiac surgery stroke risk factor analyses.Eur. J. Neurol. 2003; 10: 71-74
- Minimal extracorporeal circulation: an alternative for on-pump and off-pump coronary revascularization.Ann. Thorac. Surg. 2009; 87: 766-772
- Risk factors for early or delayed stroke after cardiac surgery.Circulation. 1999; 100: 642-647
- Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients.Ann. Thorac. Surg. 2003; 75: 472-478
- Stroke in cardiac surgical patients: determinants and outcome.Ann. Thorac. Surg. 1999; 68 (discussion 397–398): 391-397
- Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation.Circulation. 2012; 126: 3041-3053
- Arterial blood flow to the brain in patients with vascular disease: the SMART Study.Radiology. 2006; 240: 515-521
- Alterations in cerebral metabolic rate and blood supply across the adult lifespan.Cereb. Cortex. 2011; 21: 1426-1434
- Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery.J. Am. Coll. Cardiol. 2008; 51: 793-801
- The importance of prior stroke for the adjusted risk of neurologic injury after cardiac surgery for women and men.Anesthesiology. 2003; 98: 823-829
- Atrial fibrillation following cardiac surgery: clinical features and preventative strategies.Eur. Heart J. 2009; 30: 410-425
Article info
Publication history
Published online: July 04, 2015
Accepted:
July 3,
2015
Received in revised form:
June 3,
2015
Received:
March 13,
2015
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
