BACKGROUND: Advanced age is associated with increased systemic atherosclerosis and is a consistent neurologic risk factor after coronary artery bypass grafting (CABG). METHODS: We studied prospectively whether varying degrees of a total atherosclerotic score derived from the brain, carotid arteries, and ascending aorta predicted postoperative neuropsychologic (NP) dysfunction and stroke in 177 elderly patients (> or = 60 years) undergoing CABG. RESULTS: Group L (low total atherosclerotic score) had rates of NP dysfunction of 25% and 4%, group I (intermediate) had rates of 33% and 22%, and group H (high) had rates of 79% and 43% on postoperative days 1 and 7, respectively (p < 0.001). The incidence of stroke was higher in group H (14.3%) than in groups I and L (7.8% and 0.9%; p = 0.013). Stepwise logistic regression analysis demonstrated the significant predictors of NP dysfunction on postoperative day 7 to be total atherosclerotic score, peripheral vascular disease, and diabetes mellitus, and those of stroke to be total atherosclerotic score, peripheral vascular disease, and hyperlipidemia. CONCLUSIONS: Perioperative evaluation of craniocervical and aortic atherosclerosis is useful to identify a high-risk patient at postoperative NP dysfunction and stroke after CABG.
BACKGROUND: Advanced age is associated with increased systemic atherosclerosis and is a consistent neurologic risk factor after coronary artery bypass grafting (CABG). METHODS: We studied prospectively whether varying degrees of a total atherosclerotic score derived from the brain, carotid arteries, and ascending aorta predicted postoperative neuropsychologic (NP) dysfunction and stroke in 177 elderly patients (> or = 60 years) undergoing CABG. RESULTS: Group L (low total atherosclerotic score) had rates of NP dysfunction of 25% and 4%, group I (intermediate) had rates of 33% and 22%, and group H (high) had rates of 79% and 43% on postoperative days 1 and 7, respectively (p < 0.001). The incidence of stroke was higher in group H (14.3%) than in groups I and L (7.8% and 0.9%; p = 0.013). Stepwise logistic regression analysis demonstrated the significant predictors of NP dysfunction on postoperative day 7 to be total atherosclerotic score, peripheral vascular disease, and diabetes mellitus, and those of stroke to be total atherosclerotic score, peripheral vascular disease, and hyperlipidemia. CONCLUSIONS: Perioperative evaluation of craniocervical and aortic atherosclerosis is useful to identify a high-risk patient at postoperative NP dysfunction and stroke after CABG.
Authors: Carolyn Goldberg Butler; Jamahal Maeng Ho Luxford; Chuan-Chin Huang; Julius I Ejiofor; James D Rawn; Kerry Wilusz; John A Fox; Stanton K Shernan; Jochen Daniel Muehlschlegel Journal: Ann Thorac Surg Date: 2017-06-01 Impact factor: 4.330
Authors: Danielle Greaves; Peter J Psaltis; Tyler J Ross; Daniel Davis; Ashleigh E Smith; Monique S Boord; Hannah A D Keage Journal: Int J Cardiol Date: 2019-04-24 Impact factor: 4.164
Authors: Danielle Greaves; Peter J Psaltis; Daniel H J Davis; Tyler J Ross; Erica S Ghezzi; Amit Lampit; Ashleigh E Smith; Hannah A D Keage Journal: J Am Heart Assoc Date: 2020-11-07 Impact factor: 6.106