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Predictors of early, late stroke after cardiac surgery identified
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Factors such as older age, history of stroke or transient ischemic attack, peripheral vascular disease and type of surgical procedure were predictive of both postoperative stroke and stroke in the 2 years after cardiac surgery, according to study results.
Researchers evaluated data on 108,711 adults in Ontario, Canada, who underwent CABG (76.8%), isolated valve surgery (13%), or combined CABG and valve surgery (10.2%) from April 1996 to March 2007. Their goal was to identify the rate and predictors of long-term stroke after cardiac surgery.
The primary outcome was stroke within 2 years after cardiac surgery, including early stroke during the index hospitalization and late stroke after hospitalization.
Overall, 1.8% of patients experienced perioperative stroke and 3.6% developed stroke within 2 years after surgery. The mortality rates were 2.8% for those with perioperative stroke and 6.8% for those with late stroke.
Factors associated with both early and late stroke included:
- Age at least 65 years (adjusted HR=1.9; 95% CI, 1.8-2);
- History of stroke or TIA (adjusted HR=2.1; 95% CI, 1.9-2.3);
- Peripheral vascular disease (adjusted HR=1.6; 95% CI, 1.5-1.7);
- Combined CABG and valve surgery (adjusted HR=1.7; 95% CI, 1.5-1.8);
- Valve surgery only (adjusted HR=1.4; 95% CI, 1.2-1.5).
Factors associated with early stroke only included need for preoperative dialysis (adjusted OR=2.1; 95% CI, 1.6-2.8) and new-onset postoperative atrial fibrillation (adjusted OR=1.5; 95% CI, 1.3-1.6). The researchers also noted that patients without prior AF developed postoperative AF in 18.2% of cases.
Patients with a CHADS2 score of 2 or higher had an increased risk for stroke or death compared with a lower score: 19.9% vs. 9.3% for patients with a history of AF; 16.8% vs. 7.8% for patients who developed new-onset postoperative AF; 14.8% vs. 5.8% for patients without AF.
“The role of early anticoagulation, particularly in the presence of an elevated CHADS2 score, should be explored in future research,” the researchers wrote. “… Patients with an elevated score should be the focus for preventive strategies in future research, irrespective of heart rhythm.”
Disclosure: The researchers report no relevant financial disclosures.
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