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Eur J Cardiothorac Surg 2006;30:300-304
© 2006 Elsevier Science NL
Department of Thoracic & Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, 2, Ave. Martin Luther King, 87042 Limoges, France
Received 8 September 2005; received in revised form 13 March 2006; accepted 20 March 2006.
* Corresponding author. Address: Department of Thoracic & Cardiovascular Surgery and Angiology, Dupuytren University Hospital, 2, Ave. Martin Luther King, 87042 Limoges, France. Tel.: +33 555 05 63 71; fax: +33 555 05 63 84. (Email: victor.aboyans{at}unilim.fr).
Background: Despite major improvement in surgical techniques and intensive care management, stroke remains one of the most devastating complications of coronary artery bypass grafting (CABG). We aimed to determine factors predicting the occurrence of stroke during CABG. A special interest was focused on preoperative therapies. Methods: We prospectively enrolled 810 consecutive candidates for CABG alone in a specific database, including all pre- and perioperative data (history, clinical, therapeutic, cardiac catheterization, surgical and intensive care data). Univariate tests and then multiple logistic regression analysis were used to determine independent predictive factors. Results: During the first postoperative month, stroke occurred in 11 cases and transient ischemic attack (TIA) in 4 additive cases (cumulative rate: 1.85%). After the multivariate analysis, the following factors remained significant (p < 0.05) in the predictive model, with corresponding odds ratios between brackets: redo cardiac surgery (7.45), unstable cardiac status (4.74), past history of cerebrovascular disease (4.14), past history of peripheral arterial disease (3.55), whereas the presence of preoperative statins was protective (0.24, 95% IC: 0.07–0.78). The addition of perioperative data (aortic calcification, postoperative arrhythmia, on/off-pump surgery) did not change the final predictive model. Conclusion: To our knowledge, this is the first real-world observational report highlighting the interest of statins for the prevention of stroke in the very special situation of CABG. Even though according to randomized trials coronary patients have a benefit from these drugs, a special level of interest should be directed towards those presenting the above-mentioned risk factors.
Key Words: Coronary artery bypass surgery • Stroke, Cardiovascular drugs
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