Sultana Habib1, Arif ur Rehman Khan2, M Iqbal Afridi3, Anum Saeed4, Agha Fahad Jan5, Najma Amjad6. 1. Department of Adult Cardiology , National Institute of Cardiovascular Disease (NICVD), Karachi. 2. Department of Cardiovascular Surgery , National Institute of Cardiovascular Disease (NICVD), Karachi. 3. Department of Psychiatry, Jinnah Postgraduate Medical Centre (JPMC), Karachi. 4. Department of Research Assistant , National Institute of Cardiovascular Disease (NICVD), Karachi. 5. Department of Cath Lab , National Institute of Cardiovascular Disease (NICVD), Karachi. 6. Department of Anaesthesia , National Institute of Cardiovascular Disease (NICVD), Karachi.
Abstract
OBJECTIVE: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. METHODOLOGY: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. RESULTS: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. CONCLUSION: Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.
OBJECTIVE: To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. METHODOLOGY: Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. RESULTS: One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. CONCLUSION:Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.
Authors: J Burkauskas; P Lang; A Bunevičius; J Neverauskas; M Bučiūtė-Jankauskienė; N Mickuvienė Journal: J Int Med Res Date: 2018-08-29 Impact factor: 1.671