Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes
Abstract Background Despite the improved medical and surgical managements, still there is a significant risk of developing acute cerebrovascular strokes after coronary artery bypass grafting (CABG). Our objectives were to study the immediate and long-term outcomes after CABG and to identify the poss...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-10-01
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| Series: | The Egyptian Heart Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43044-022-00315-4 |
| _version_ | 1798028506881327104 |
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| author | Mohamed Laimoud Mary Maghirang Mosleh Alanazi Shatha M. Al-Mutlaq Suha A. Althibait Boshra Alanazi Munirah Alomran Zohair Al Halees |
| author_facet | Mohamed Laimoud Mary Maghirang Mosleh Alanazi Shatha M. Al-Mutlaq Suha A. Althibait Boshra Alanazi Munirah Alomran Zohair Al Halees |
| author_sort | Mohamed Laimoud |
| collection | DOAJ |
| description | Abstract Background Despite the improved medical and surgical managements, still there is a significant risk of developing acute cerebrovascular strokes after coronary artery bypass grafting (CABG). Our objectives were to study the immediate and long-term outcomes after CABG and to identify the possible predictors of post-CABG strokes. Results Between January 2016 and August 2020, 410 adult patients, mostly males (82.2%), were retrospectively enrolled after CABG. Acute postoperative strokes occurred in 31 (7.5%) patients; of them, 30 (96.8%) patients had ischemic stroke, while 1 (3.2%) had hemorrhagic stroke. Mechanical thrombectomy was done in two cases. The patients who developed acute cerebral stroke had significantly higher admission (p = 0.02) and follow-up (p < 0.001) SOFA scores, higher arterial blood lactate level (p < 0.001), longer hospitalization (p < 0.001) and more hospital mortality (p < 0.001) compared with the patients who did not develop stroke. Kaplan–Meier curves for 5-year mortality showed increased risk in those patients with postoperative stroke (HR: 23.03; 95% CI: 6.10–86.92, p < 0.001). After multivariate regression, the predictors of early postoperative stroke were carotid artery stenosis (CAS), postoperative atrial fibrillation, cardiopulmonary bypass time, prior cerebral stroke, admission SOFA score and chronic kidney disease (CKD). The predictors of late cerebrovascular stroke were CAS, combined CABG and valve surgery, CKD, atrial fibrillation, prior stroke and HbA1c. Conclusions The development of post-CABG acute cerebrovascular stroke is associated with longer hospitalization, multiple morbidities and increased mortality. Careful assessment and management of risk factors especially atrial fibrillation and carotid artery stenosis should be implemented to decrease this substantial complication after CABG. |
| first_indexed | 2024-04-11T19:10:19Z |
| format | Article |
| id | doaj.art-05a4c7404b224edeb7e3da0394073274 |
| institution | Directory Open Access Journal |
| issn | 2090-911X |
| language | English |
| last_indexed | 2024-04-11T19:10:19Z |
| publishDate | 2022-10-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Heart Journal |
| spelling | doaj.art-05a4c7404b224edeb7e3da03940732742022-12-22T04:07:38ZengSpringerOpenThe Egyptian Heart Journal2090-911X2022-10-0174111110.1186/s43044-022-00315-4Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokesMohamed Laimoud0Mary Maghirang1Mosleh Alanazi2Shatha M. Al-Mutlaq3Suha A. Althibait4Boshra Alanazi5Munirah Alomran6Zohair Al Halees7Cardiac Critical Care Department, King Faisal Specialist Hospital and Research CenterCardiac Critical Care Department, King Faisal Specialist Hospital and Research CenterCardiac Critical Care Department, King Faisal Specialist Hospital and Research CenterCardiac Surgery Department, King Faisal Specialist Hospital and Research CenterCardiac Surgery Department, King Faisal Specialist Hospital and Research CenterCollege of Medicine, Almaarefa UniversityCardiac Critical Care Department, King Faisal Specialist Hospital and Research CenterCardiac Surgery Department, King Faisal Specialist Hospital and Research CenterAbstract Background Despite the improved medical and surgical managements, still there is a significant risk of developing acute cerebrovascular strokes after coronary artery bypass grafting (CABG). Our objectives were to study the immediate and long-term outcomes after CABG and to identify the possible predictors of post-CABG strokes. Results Between January 2016 and August 2020, 410 adult patients, mostly males (82.2%), were retrospectively enrolled after CABG. Acute postoperative strokes occurred in 31 (7.5%) patients; of them, 30 (96.8%) patients had ischemic stroke, while 1 (3.2%) had hemorrhagic stroke. Mechanical thrombectomy was done in two cases. The patients who developed acute cerebral stroke had significantly higher admission (p = 0.02) and follow-up (p < 0.001) SOFA scores, higher arterial blood lactate level (p < 0.001), longer hospitalization (p < 0.001) and more hospital mortality (p < 0.001) compared with the patients who did not develop stroke. Kaplan–Meier curves for 5-year mortality showed increased risk in those patients with postoperative stroke (HR: 23.03; 95% CI: 6.10–86.92, p < 0.001). After multivariate regression, the predictors of early postoperative stroke were carotid artery stenosis (CAS), postoperative atrial fibrillation, cardiopulmonary bypass time, prior cerebral stroke, admission SOFA score and chronic kidney disease (CKD). The predictors of late cerebrovascular stroke were CAS, combined CABG and valve surgery, CKD, atrial fibrillation, prior stroke and HbA1c. Conclusions The development of post-CABG acute cerebrovascular stroke is associated with longer hospitalization, multiple morbidities and increased mortality. Careful assessment and management of risk factors especially atrial fibrillation and carotid artery stenosis should be implemented to decrease this substantial complication after CABG.https://doi.org/10.1186/s43044-022-00315-4CABGCoronary artery bypass graftingSOFA scoreAcute cerebrovascular strokeChronic kidney diseaseCarotid artery stenosis |
| spellingShingle | Mohamed Laimoud Mary Maghirang Mosleh Alanazi Shatha M. Al-Mutlaq Suha A. Althibait Boshra Alanazi Munirah Alomran Zohair Al Halees Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes The Egyptian Heart Journal CABG Coronary artery bypass grafting SOFA score Acute cerebrovascular stroke Chronic kidney disease Carotid artery stenosis |
| title | Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes |
| title_full | Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes |
| title_fullStr | Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes |
| title_full_unstemmed | Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes |
| title_short | Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes |
| title_sort | predictors and clinical outcomes of post coronary artery bypass grafting cerebrovascular strokes |
| topic | CABG Coronary artery bypass grafting SOFA score Acute cerebrovascular stroke Chronic kidney disease Carotid artery stenosis |
| url | https://doi.org/10.1186/s43044-022-00315-4 |
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