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Impact of preoperative neurologic events on outcomes after coronary artery bypass grafting.
Ann Thorac Surg. 2008 Aug; 86(2):504-10; discussion 510.AT

Abstract

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.

Authors+Show Affiliations

Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30308, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18640324

Citation

Halkos, Michael E., et al. "Impact of Preoperative Neurologic Events On Outcomes After Coronary Artery Bypass Grafting." The Annals of Thoracic Surgery, vol. 86, no. 2, 2008, pp. 504-10; discussion 510.
Halkos ME, Puskas JD, Lattouf OM, et al. Impact of preoperative neurologic events on outcomes after coronary artery bypass grafting. Ann Thorac Surg. 2008;86(2):504-10; discussion 510.
Halkos, M. E., Puskas, J. D., Lattouf, O. M., Kilgo, P., Guyton, R. A., & Thourani, V. H. (2008). Impact of preoperative neurologic events on outcomes after coronary artery bypass grafting. The Annals of Thoracic Surgery, 86(2), 504-10; discussion 510. https://doi.org/10.1016/j.athoracsur.2008.04.011
Halkos ME, et al. Impact of Preoperative Neurologic Events On Outcomes After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2008;86(2):504-10; discussion 510. PubMed PMID: 18640324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of preoperative neurologic events on outcomes after coronary artery bypass grafting. AU - Halkos,Michael E, AU - Puskas,John D, AU - Lattouf,Omar M, AU - Kilgo,Patrick, AU - Guyton,Robert A, AU - Thourani,Vinod H, PY - 2007/11/06/received PY - 2008/03/31/revised PY - 2008/04/01/accepted PY - 2008/7/22/pubmed PY - 2008/9/4/medline PY - 2008/7/22/entrez SP - 504-10; discussion 510 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 86 IS - 2 N2 - 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. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/18640324/Impact_of_preoperative_neurologic_events_on_outcomes_after_coronary_artery_bypass_grafting_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)00745-5 DB - PRIME DP - Unbound Medicine ER -