ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Bruce J. Leavitt
Charles A. S. Marrin
Ronald M. Weintraub
Yvon R. Baribeau
David C. Charlesworth
John H. Braxton
Felix Hernandez, Jr
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Likosky, D. S.
Right arrow Articles by O’Connor, G. T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Likosky, D. S.
Right arrow Articles by O’Connor, G. T.
Related Collections
Right arrow Coronary disease

Ann Thorac Surg 2003;76:428-434
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Intra- and postoperative predictors of stroke after coronary artery bypass grafting

Donald S. Likosky, PhDa*, Bruce J. Leavitt, MDb, Charles A. S. Marrin, MB, BSa, David J. Malenka, MDa, Alexander G. Reeves, MDa, Ronald M. Weintraub, MDc, Louis R. Caplan, MDd, Yvon R. Baribeau, MDe, David C. Charlesworth, MDe, Cathy S. Ross, MSa, John H. Braxton, MDf, Felix Hernandez, Jr, MDg, Gerald T. O’Connor, DSc, PhDa Northern New England Cardiovascular Disease Study Group

a Departments of Medicine, Surgery, and Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
b Department of Surgery, Fletcher Allen Health Care, Burlington, Vermont, USA
c Department of Surgery, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
d Department of Neurology, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
e Department of Surgery, Catholic Medical Center, Manchester, New Hampshire, USA
f Department of Surgery, Maine Medical Center, Portland, Maine, USA
g Department of Surgery, Eastern Maine Medical Center, Bangor, Maine USA

Accepted for publication March 4, 2003.

* Address reprint requests to Dr Likosky, Clinical Research Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
e-mail: donald.s.likosky{at}dartmouth.edu

BACKGROUND: Stroke is a devastating complication of coronary artery bypass graft surgery. An individual’s risk of stroke is based in part on preoperative characteristics but also on intra- and postoperative factors. We developed a risk prediction model for stroke based on factors in intra- and postoperative care, after adjusting for a patient’s preoperative risk.

METHODS: We conducted a regional prospective study of 11,825 consecutive patients undergoing coronary artery bypass graft surgery surgery from 1996 to 2001. Data were collected on patient and disease characteristics, intra- and postoperative care and course, and outcomes. Stroke was defined as "a new focal neurologic deficit which appears and is still at least partially evident more than 24 hours after its onset." Logistic regression identified significant predictors of stroke.

RESULTS: The incidence of stroke was 1.5%. The regression model significantly predicted the occurrence of stroke. As compared with cardiopulmonary bypass for less than 90 minutes, cardiopulmonary bypass for 90 to 113 minutes, odds ratio = 1.59, p = 0.022), cardiopulmonary bypass for 114 minutes or more (odds ratio = 2.36, p < 0.001), atrial fibrillation (odds ratio = 1.82, p < 0.001), and prolonged inotrope use (odds ratio = 2.59, p = 0.001) significantly improved our ability to predict stroke. Nearly 75% of all strokes occurred among the 90% of patients at low or medium preoperative risk.

CONCLUSIONS: The inclusion of factors associated with intra- and postoperative care and course significantly improved the prediction model. Most strokes occurred among patients at low or medium preoperative risk, suggesting that many of these strokes may be preventable. Reduction in stroke risk may require modifications in intra- and postoperative care and course.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
T. C. Lisle, K. M. Barrett, L. M. Gazoni, B. R. Swenson, C. D. Scott, A. Kazemi, J. A. Kern, B. B. Peeler, I. L. Kron, and K. C. Johnston
Timing of stroke after cardiopulmonary bypass determines mortality.
Ann. Thorac. Surg., May 1, 2008; 85(5): 1556 - 1562.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
S. J. Durham and J. P. Gold
Late Complications of Cardiac Surgery
Card. Surg. Adult, January 1, 2008; 3(2008): 535 - 548.
[Full Text]

Home page
 Ann. Thorac. Surg.Home page
A. Zierer, S. J. Melby, R. K. Voeller, T. J. Guthrie, A. S. Al-Dadah, B. F. Meyers, M. K. Pasque, G. A. Ewald, M. R. Moon, and N. Moazami
Significance of Neurologic Complications in the Modern Era of Cardiac Transplantation
Ann. Thorac. Surg., May 1, 2007; 83(5): 1684 - 1690.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Kollar, S. D. Lick, K. N. Vasquez, and V. R. Conti
Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?
Ann. Thorac. Surg., August 1, 2006; 82(2): 515 - 523.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
K. G. Shann, D. S. Likosky, J. M. Murkin, R. A. Baker, Y. R. Baribeau, G. R. DeFoe, T. A. Dickinson, T. J. Gardner, H. P. Grocott, G. T. O'Connor, et al.
An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response.
J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 283 - 290.e3.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. W. Hammon, D. A. Stump, J. F. Butterworth, D. M. Moody, K. Rorie, D. D. Deal, E. H. Kincaid, T. E. Oaks, and N. D. Kon
Single crossclamp improves 6-month cognitive outcome in high-risk coronary bypass patients: The effect of reduced aortic manipulation
J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 114 - 121.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. F. Berry, M. L. McGarvey, L. Zeng, and Y. J. Woo
Neurological Monitoring and Off-Pump Surgery in a Very High-Risk Stroke Patient
Ann. Thorac. Surg., December 1, 2005; 80(6): 2372 - 2374.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
D. S. Likosky, W. C. Nugent, and C. S. Ross
Improving Outcomes of Cardiac Surgery Through Cooperative Efforts: The Northern New England Experience
Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2005; 9(2): 119 - 121.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. J. Dacey, D. S. Likosky, B. J. Leavitt, S. J. Lahey, R. D. Quinn, F. Hernandez Jr, H. B. Quinton, J. P. Desimone, C. S. Ross, G. T. O'Connor, et al.
Perioperative Stroke and Long-Term Survival After Coronary Bypass Graft Surgery
Ann. Thorac. Surg., February 1, 2005; 79(2): 532 - 536.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
A. A. Fox, S. K. Shernan, and S. C. Body
Predictive Genomics of Adverse Events After Cardiac Surgery
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 297 - 315.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. I. Kapetanakis, S. C. Stamou, M. K.C. Dullum, P. C. Hill, E. Haile, S. W. Boyce, A. S. Bafi, K. R. Petro, and P. J. Corso
The Impact of Aortic Manipulation on Neurologic Outcomes After Coronary Artery Bypass Surgery: A Risk-Adjusted Study
Ann. Thorac. Surg., November 1, 2004; 78(5): 1564 - 1571.
[Abstract] [Full Text] [PDF]

Home page
 PerfusionHome page
R C Groom, D S Likosky, R J Forest, G T O'Connor, J R Morton, C S Ross, C Clark, and R Kramer
A model for cardiopulmonary bypass redesign
Perfusion, July 1, 2004; 19(4): 257 - 261.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2003 by The Society of Thoracic Surgeons.