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Stroke in CABG-treated patients declined during 27-year period
Tarakji K. JAMA. 2011;305:381-390.
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Results from a prospective, single-center study conducted between 1982 and 2009 suggest that patients undergoing CABG surgery had a decreased rate of stroke despite an increased patient risk profile.
In the study, 45,432 consecutive patients (mean age, 63 years) from the Cleveland Clinic underwent CABG surgery. Researchers recorded strokes that occurred after CABG and classified them as occurring intraoperatively or postoperatively.
During the 27 years, 705 patients (1.6%) had a stroke, with 279 occurring intraoperatively and 409 occurring postoperatively. The prevalence of stroke peaked at 2.6% in 1988 but decreased by 4.69% per year (P=.04) afterward, even with increasing patient comorbidity.
Older age and variables of arteriosclerotic burden were also reported as risk factors for intraoperative and postoperative stroke. Lowest intraoperative stroke rates were reported with on-pump beating-heart CABG (0%) and off-pump CABG (0.14%), whereas the highest was found with on-pump CABG with hypothermic circulatory arrest (5.3%).
Khaldoun G. Tarakji, MD, and colleagues said the decrease in occurrence of stroke but increase in patient risk profile is likely the result of improving preoperative assessment, intraoperative anesthetic and surgical techniques, and postoperative care.
“Further studies are needed to develop better strategies to minimize the occurrence of stroke among patients undergoing CABG,” they said.
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