PREDICTORS OF CEREBROVASCULAR DISORDERS IN PATIENTS AFTER CORONARY BYPASS GRAFTING

• Main Authors: S. G. Sukhanov, A. V. Marchenko, P. A. Myalyuk, V. B. Arutyunyan, V. A. Chragyan, E. V. Demakova, A. S. Vronskiy
• Format: Article
• Language: Russian
• Published: MONIKI 2016-02-01
• Series: Alʹmanah Kliničeskoj Mediciny
• Subjects: coronary artery bypass grafting; predictors; stroke
• Online Access: https://www.almclinmed.ru/jour/article/view/269

Background: At present, coronary bypass graft (CABG) that was first introduced more than 45 years ago, is one of the most common types of surgeries in the world. Despite progress and improvements in myocardial revascularization techniques and methods aimed at higher safety of the intervention, postoperative cerebrovascular complications continue to be one of the most common problems.Aim: To identify predictors of perioperative stroke in patients undergoing CABG.Materials and methods: From January 2013 to December 2014, 2823 isolated CABG procedures have been done.Results: All-cause in-hospital mortality after isolated CABG was 1.2% (n = 36). Perioperative strokes were diagnosed in 32 (1.1%) of patients. For subsequent analysis, we divided all patients into two groups. Group A included 32 patients who had a stroke in their postoperative period, group B comprised 2791 patients without severe cerebrovascular disorders. There were more female patients in group A, compared to group B (13/32 [40.6%] vs. 543/2791 [19.5%], respectively (р < 0.01)), more elderly patients (21 [65.6%] vs. 1251 [44.8%] (р < 0,05) above 60 years of age, and 9 [28.1%] vs. 348 [12.5%] (р < 0.05) above 70 years, respectively). In group B, the number of patients with atrial fibrillation was 244 (8.7%) vs. 7 (21.9%) in group A, the difference being statistically significant at р < 0.01. Among those with stroke, diabetes was found in 12 (37.5%) of patients, among those who did not have a stroke, in 212 (7.6%) (p < 0.01). Significant differences were found between numbers of patients with atherosclerosis of brachyocephalic arteries (17 [53.1%] in group A vs. 624 [22.4%] in group B, p < 0.01) and atherosclerosis of lower limb arteries (16 [50%] vs. 715 [25.6%] (p < 0.01), respectively.Conclusion: The most significant prognostic factors affecting the risk of perioperative stroke are concomitant atherosclerosis of brachyocephalic arteries, of lower limb arteries, atrial fibrillation, diabetes mellitus, as well as older age. Severe cerebrovascular events were significantly more frequent in females.