Incidence and predictors of intracranial bleeding after coronary artery bypass graft surgery

Ju Hyeon Kim; Pil Hyung Lee; Ho Jin Kim; Joon Bum Kim; Sojeong Park; Dae-Sung Kyoung; Soo-Jin Kang; Seung-Whan Lee; Young-Hak Kim; Cheol Whan Lee; Cheol Hyun Chung; Jae Won Lee; Seong-Wook Park

doi:10.3389/fcvm.2022.863590

Incidence and predictors of intracranial bleeding after coronary artery bypass graft surgery

Front Cardiovasc Med. 2022 Aug 12:9:863590. doi: 10.3389/fcvm.2022.863590. eCollection 2022.

Authors

Affiliations

¹ Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
² Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea.

Abstract

Background: There is a paucity of direct data on the incidence and predictors of intracranial bleeding (ICB) after coronary artery bypass graft surgery (CABG).

Methods: The Korean National Health Insurance database was used to identify patients without prior ICB who underwent CABG. The outcomes of interest were the time-dependent incidence rates of ICB and the associated mortality.

Results: Among 35,021 patients who underwent CABG between 2007 and 2018, 895 (2.6%) experienced an ICB during a median follow-up of 6.0 years. The 1-year cumulative incidence of ICB was 0.76%, with a relatively high incidence rate (9.93 cases per 1,000 person-years) within the first 1-30 days. Subsequent incidence rates showed a sharp decline until 3 years, followed by a steady decrease up to 10 years. The 1-year mortality rate after ICB was 38.1%, with most deaths occurring within 30 days (23.6%). The predictors of ICB after CABG were age ≥ 75 years, hypertension, pre-existing dementia, history of ischemic stroke or transient ischemic attack, and end-stage renal disease.

Conclusions: In an unselected nationwide population undergoing CABG, the incidence of ICB was non-negligible and showed a relatively high incidence rate during the early postoperative period. Post-CABG ICB was associated with a high risk of premature death. Further research is needed to stratify high-risk patients and personalize therapeutic decisions for preventing ICB after CABG.

Keywords: atherosclerosis; coronary artery bypass graft; intracranial bleeding; intracranial hemorrhage; mortality.