F Hornero1, E Martín1, A V Mena-Durán1, R Rodríguez2, M Castellà3, C Porras4, B Romero5, L Maroto6, Pérez de la Sota E7, Mª Echevarría8, M J Dalmau9, L Díez10, J Buendía11, F Enríquez12, M Castaño13, G Reyes14, A Ginel15, M Pérez16, J Barquero17, A Jiménez18, E Castedo19, G Pradas20, M Gómez21. 1. Instituto Cardiovascular. Heart Surgery Dept. Hospital General Universitario. Avda. Tres Cruces, s/n Valencia (Spain). 2. Heart Surgery Dept. Hospital Vall d'Hebrón. Barcelona. Passeig de la Vall d'Hebron, 119. Barcelona (Spain). 3. Heart Surgery Dept. Hospital Clinic I Provincial. Carrer Villarroel, 170. Barcelona (Spain). 4. Heart Surgery Dept. Hospital Clínico Universitario Virgen de la Victoria. Avda. Cervantes,2. Málaga (Spain). 5. Heart Surgery Dept. Hospital Germans Trias i Pujol. Ctra. Canyet, S/N. Badalona (Spain). 6. Heart Surgery Dept. Hospital Clínico San Carlos. Calle Profesor Martín Lagos, s/n. Madrid (Spain). 7. Heart Surgery Dept. Hospital Doce de Octubre. Avda. de Córdoba, s/n. Madrid (Spain). 8. Heart Surgery Dept. Hospital Clínico Universitario. Avda. Ramón y Cajal s/n. Valladolid (Spain). 9. Heart Surgery Dept. Hospital Universitario. Calle San Vicente, 58. Salamanca (Spain). 10. Heart Surgery Dept. Hospital Marqués de Valdecilla. Avenida Valdecilla, s/n Santander (Spain). 11. Heart Surgery Dept. Complejo Hospitalario. Av. de Barber, 30. Toledo (Spain). 12. Heart Surgery Dept. Hospital Son Espases. Carretera de Valldemossa, 79. Palma de Mallorca (Spain). 13. Heart Surgery Dept. Complejo Asistencial Hospital of León. Altos de Nava s/n. León (Spain). 14. Heart Surgery Dept. Hospital de La Princesa. C/ Diego de León, 62. Madrid (Spain. 15. Heart Surgery Dept. Hospital de la Santa Creu i Sant Pau. C/ Sant Quintí, 89. Barcelona (Spain). 16. Heart Surgery Dept. Hospital Universitari i Politècnic La Fe. Bulevar Sur, s/n. Valencia (Spain). 17. Heart Surgery Dept. Hospital Universitario Virgen Macarena. Av. Dr. Fedriani, 3. Sevilla (Spain). 18. Heart Surgery Dept. Hospital Fundación Jiménez Díaz. Avda. Reyes Católicos, 2 Madrid (Spain). 19. Heart Surgery Dept. Hospital Universitario Puerta de Hierro. Calle Joaquin Rodrigo, 2 Majadahonda (Spain). 20. Heart Surgery Dept. Hospital Xeral. C/ Pizarro, 22.Vigo (Spain). 21. Heart Surgery Dept. Hospital Universitario Puerta del Mar. Avda. Ana de Viya, 21. Cádiz (Spain).
Abstract
Background: The present multicentre study was aimed at determining the effect of preoperative atrial fibrillation (preop-AF) as stroke risk factor in coronary artery bypass graft surgery (CABG) during the perioperative period. Methods: Patients undergoing isolated CABG surgery were enrolled from 21 Spanish centers. Baseline variables related with perioperative stroke risk were recorded and analysed. The Northern New England Cardiovascular Disease Study Group (NNECVDSG) stroke risk schema was used to stratify stroke risk and compare predicted vs observed neurologic outcomes in this study. Results: 26347 patients were enrolled in the study. Prevalence of preop-AF was 4.2%, and was associated significantly with major cardiovascular comorbidities. The stroke rate was 1.38% (365 strokes), and it was slightly higher for patients with preop-AF vs non preop-AF, 1.82% vs 1.36%, p = 0.2. NNECVDSG schema showed good predictive ability calculating the area under the receiver operating characteristic curve (c-statistic 0.696; 95% CI 0.668 to 0.723). To investigate the associations of baseline preoperative variables with perioperative CABG-stroke a logistic regression model was performed. Preop-AF impact on perioperative stroke was lower that other variables. Preop-AF did not show an adverse impact in the quartiles groups according to NNECVDSG Stroke Risk Index. Conclusion: Risk of perioperative stroke in isolated CABG surgery patients is not significantly increased by preop-AF.
Background: The present multicentre study was aimed at determining the effect of preoperative atrial fibrillation (preop-AF) as stroke risk factor in coronary artery bypass graft surgery (CABG) during the perioperative period. Methods:Patients undergoing isolated CABG surgery were enrolled from 21 Spanish centers. Baseline variables related with perioperative stroke risk were recorded and analysed. The Northern New England Cardiovascular Disease Study Group (NNECVDSG) stroke risk schema was used to stratify stroke risk and compare predicted vs observed neurologic outcomes in this study. Results: 26347 patients were enrolled in the study. Prevalence of preop-AF was 4.2%, and was associated significantly with major cardiovascular comorbidities. The stroke rate was 1.38% (365 strokes), and it was slightly higher for patients with preop-AF vs non preop-AF, 1.82% vs 1.36%, p = 0.2. NNECVDSG schema showed good predictive ability calculating the area under the receiver operating characteristic curve (c-statistic 0.696; 95% CI 0.668 to 0.723). To investigate the associations of baseline preoperative variables with perioperative CABG-stroke a logistic regression model was performed. Preop-AF impact on perioperative stroke was lower that other variables. Preop-AF did not show an adverse impact in the quartiles groups according to NNECVDSG Stroke Risk Index. Conclusion: Risk of perioperative stroke in isolated CABG surgery patients is not significantly increased by preop-AF.
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