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.
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: William T Daniel; Patrick Kilgo; John D Puskas; Vinod H Thourani; Omar M Lattouf; Robert A Guyton; Michael E Halkos Journal: J Thorac Cardiovasc Surg Date: 2013-03-08 Impact factor: 5.209
Authors: Mario Gaudino; Gianni D Angelini; Charalambos Antoniades; Faisal Bakaeen; Umberto Benedetto; Antonio M Calafiore; Antonino Di Franco; Michele Di Mauro; Stephen E Fremes; Leonard N Girardi; David Glineur; Juan Grau; Guo-Wei He; Carlo Patrono; John D Puskas; Marc Ruel; Thomas A Schwann; Derrick Y Tam; James Tatoulis; Robert Tranbaugh; Michael Vallely; Marco A Zenati; Michael Mack; David P Taggart Journal: J Am Heart Assoc Date: 2018-08-21 Impact factor: 5.501