Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes

Mohamed Laimoud; Mary Maghirang; Mosleh Alanazi; Shatha M Al-Mutlaq; Suha A Althibait; Boshra Alanazi; Munirah Alomran; Zohair Al Halees

doi:10.1186/s43044-022-00315-4

Predictors and clinical outcomes of post-coronary artery bypass grafting cerebrovascular strokes

Egypt Heart J. 2022 Oct 18;74(1):76. doi: 10.1186/s43044-022-00315-4.

Authors

Mohamed Laimoud^{1

2}, Mary Maghirang³, Mosleh Alanazi³, Shatha M Al-Mutlaq⁴, Suha A Althibait⁴, Boshra Alanazi⁵, Munirah Alomran³, Zohair Al Halees⁴

Affiliations

¹ Cardiac Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. mlaimoud@kfshrc.edu.sa.
² Critical Care Medicine Department, Cairo University, Cairo, Egypt. mlaimoud@kfshrc.edu.sa.
³ Cardiac Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
⁴ Cardiac Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
⁵ College of Medicine, Almaarefa University, Riyadh, Saudi Arabia.

Abstract

Background: Despite the improved medical and surgical managements, still there is a significant risk of developing acute cerebrovascular strokes after coronary artery bypass grafting (CABG). Our objectives were to study the immediate and long-term outcomes after CABG and to identify the possible predictors of post-CABG strokes.

Results: Between January 2016 and August 2020, 410 adult patients, mostly males (82.2%), were retrospectively enrolled after CABG. Acute postoperative strokes occurred in 31 (7.5%) patients; of them, 30 (96.8%) patients had ischemic stroke, while 1 (3.2%) had hemorrhagic stroke. Mechanical thrombectomy was done in two cases. The patients who developed acute cerebral stroke had significantly higher admission (p = 0.02) and follow-up (p < 0.001) SOFA scores, higher arterial blood lactate level (p < 0.001), longer hospitalization (p < 0.001) and more hospital mortality (p < 0.001) compared with the patients who did not develop stroke. Kaplan-Meier curves for 5-year mortality showed increased risk in those patients with postoperative stroke (HR: 23.03; 95% CI: 6.10-86.92, p < 0.001). After multivariate regression, the predictors of early postoperative stroke were carotid artery stenosis (CAS), postoperative atrial fibrillation, cardiopulmonary bypass time, prior cerebral stroke, admission SOFA score and chronic kidney disease (CKD). The predictors of late cerebrovascular stroke were CAS, combined CABG and valve surgery, CKD, atrial fibrillation, prior stroke and HbA1c.

Conclusions: The development of post-CABG acute cerebrovascular stroke is associated with longer hospitalization, multiple morbidities and increased mortality. Careful assessment and management of risk factors especially atrial fibrillation and carotid artery stenosis should be implemented to decrease this substantial complication after CABG.

Keywords: Acute cerebrovascular stroke; CABG; Cardiopulmonary bypass; Carotid artery stenosis; Chronic kidney disease; Coronary artery bypass grafting; Mechanical thrombectomy; Mortality; Postoperative atrial fibrillation; SOFA score.