RISK-FACTORS FOR STROKE FOLLOWING CORONARY-BYPASS SURGERY

被引:50
作者
RAO, V [1 ]
CHRISTAKIS, GT [1 ]
WEISEL, RD [1 ]
IVANOV, J [1 ]
PENISTON, CM [1 ]
IKONOMIDIS, JS [1 ]
SHIRAI, T [1 ]
机构
[1] TORONTO GEN HOSP,DIV CARDIOVASC SURG,TORONTO,ON M5G 2C4,CANADA
关键词
D O I
10.1111/j.1540-8191.1995.tb00679.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Improvements in surgical technique and advances in myocardial protection have resulted in low rates of morbidity and mortality despite a greater incidence of high-risk patients. Noncardiac morbidity prolongs hospital stays and increases the costs of cardiac surgery. This study examines the preoperative predictors of stroke following isolated coronary bypass surgery. The clinical records of 3910 consecutive patients who underwent isolated coronary bypass surgery at the University of Toronto were reviewed. Stepwise logistic regression identified six independent predictors of stroke following CABG (percent in parentheses) and calculated factor adjusted odds ratios (OR) for each risk factor. Triple vessel coronary artery disease was the most important predictor (1.9%, OR 5.71), followed by normothermic systemic perfusion (3.8%, OR 4.85), age > 70 years (3.2%, OR 3.88), a previous history of transient ischemic attacks or stroke prior to surgery (6.1%, OR 3.7), peripheral vascular disease (4.7%, OR 2.77), and diabetes mellitus (2.6%, OR 2.01). The mechanism of stroke is likely different between these high-risk groups and strategies to prevent postoperative stroke should focus on the mechanisms responsible in high-risk patients.
引用
收藏
页码:468 / 474
页数:7
相关论文
共 20 条
[1]  
Christakis GT, Birnbaum PL, Weisel RD, Et al., The changing pattern of coronary bypass surgery, Circulation, 80, pp. 151-161, (1989)
[2]  
Higgins TL, Estafanous FG, Loop FD, Et al., Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients, JAMA, 267, pp. 3444-3448, (1992)
[3]  
Cosgrove DM, Loop FD, Lytle BW, Et al., Primary myocardial revascularization: Trends in surgical mortality, J Thorac Cardiovasc Surg, 88, pp. 673-684, (1984)
[4]  
Lichtenstein SV, Ashe KA, El Dalati H, Et al., Warm heart surgery, J Thorac Cardiovasc Surg, 101, pp. 269-274, (1991)
[5]  
Martin TD, Craver JM, Gott JP, Et al., (1994)
[6]  
Lynn GM, Stefanko K, Reed JF, Et al., Risk factors for stroke after coronary artery bypass, J Thorac Cardiovasc Surg, 104, pp. 1518-1523, (1992)
[7]  
Gardner TJ, Horneffer PJ, Manolio TA, Et al., Stroke following coronary artery bypass grafting: A ten‐year study, Ann Thorac Surg, 40, pp. 574-581, (1985)
[8]  
Tuman KJ, McCarthy RJ, Najafi H, Et al., Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations, J Thorac Cardiovasc Surg, 104, pp. 1510-1517, (1992)
[9]  
Barzilai B, Marshall WG, Saffitz JE, Et al., pp. 275-279, (1989)
[10]  
Blauth CI, Cosgrove DM, Webb BW, Et al., Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery, J Thorac Cardiovasc Surg, 103, pp. 1104-1112, (1992)