Document Detail

Impact of preoperative neurologic events on outcomes after coronary artery bypass grafting.
MedLine Citation:
PMID:  18640324     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Neurologic events (permanent stroke and transient events) can be devastating complications after coronary artery bypass grafting (CABG). This study assessed the impact of a history of preoperative neurologic events on postoperative outcomes in patients undergoing off-pump coronary artery bypass (OPCAB) vs conventional coronary artery bypass (CCAB). METHODS: From January 1996 to June 2006, 14,278 patients underwent primary, isolated CABG (5641 OPCAB and 8637 CCAB) at Emory Healthcare Hospitals and were prospectively entered into a computerized database. In a multiple logistic regression analysis using propensity score adjustment, we evaluated the impact of preoperative neurologic events on in-hospital mortality and postoperative neurologic events in patients undergoing OPCAB vs CCAB using adjusted odds ratios (AOR). RESULTS: Overall, postoperative neurologic events occurred in 1.9% (274 of 14,278) of patients and were associated with an in-hospital mortality of 13.5% (37 of 274). In the logistic regression analysis, patients with preoperative neurologic events had a higher incidence of postoperative neurologic events (AOR, 3.07; p < 0.0001) and in-hospital mortality (AOR, 2.19; p < 0.0001). The OPCAB patients were less likely to have postoperative neurologic events compared with CCAB patients (AOR, 0.49; p < 0.001). However, no significant interaction existed between preoperative neurologic events and operation type for any of the postoperative comparisons. CONCLUSIONS: Preoperative neurologic events are risk factors for postoperative neurologic events and in-hospital mortality. OPCAB is associated with a reduced risk of postoperative neurologic events compared with CCAB. However, OPCAB does not confer additional risk reduction in patients with preoperative neurologic events.
Michael E Halkos; John D Puskas; Omar M Lattouf; Patrick Kilgo; Robert A Guyton; Vinod H Thourani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  86     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-21     Completed Date:  2008-09-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  504-10; discussion 510     Citation Subset:  AIM; IM    
Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30308, USA.
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MeSH Terms
Atrial Fibrillation / epidemiology
Coronary Artery Bypass* / adverse effects,  mortality
Coronary Artery Bypass, Off-Pump
Hospital Mortality
Ischemic Attack, Transient / epidemiology*
Length of Stay
Middle Aged
Odds Ratio
Postoperative Complications / epidemiology*
Retrospective Studies
Risk Factors
Stroke / epidemiology*
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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