HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dieleman, J. Articles by Van Dijk, D. Search for Related Content PubMed Articles by Dieleman, J. Articles by Van Dijk, D. Related Collections Cardiac - other Cerebral protection Coronary disease

Presence of coronary collaterals is associated with a decreased incidence of cognitive decline after coronary artery bypass surgery

^a Division of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, The Netherlands
^b Department of Neurology, University Medical Center Utrecht, The Netherlands
^c Department of Cardiology/Heart Lung Center Utrecht, University Medical Center Utrecht, The Netherlands
^d Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands

Received 18 July 2008; received in revised form 8 October 2008; accepted 9 October 2008.

^_* Corresponding author. Address: Division of Perioperative Care and Emergency Medicine, Heidelberglaan 100, Mail stop Q04.2.313, 3584 CX Utrecht, The Netherlands. Tel.: +31 88 7555555; fax: +31 30 2541828. (Email: S.Dieleman{at}UMCUtrecht.nl).

Objective: Coronary artery bypass grafting (CABG) is associated with significant cerebral morbidity, usually manifested as cognitive decline or stroke. The underlying mechanism leading to cognitive decline is still unclear. Presence of coronary collateral arteries, which may reflect an overall better cardiovascular condition, recently appeared to relate to a better cardiac outcome after CABG. In this study, we investigated the hypothesis that presence of coronary collaterals is associated with less cognitive decline after coronary artery bypass grafting. Methods: Data from 281 patients undergoing first-time coronary artery bypass grafting were used. Presence of coronary collaterals was determined on the preoperative angiogram. Cognitive function was evaluated before the operation, at 3 and 12 months and 5 years thereafter by standardised neuropsychological assessment. Cognitive decline in individuals was determined by calculating the reliable change score, a cognitive change score corrected for natural testing variability and practice effects. Results: Cognitive decline was found in 19 (8%) patients at 3 months, in 31 (12%) patients at 12 months and in 82 (34%) at 5 years follow-up. Presence of coronary collaterals was independently associated with a better cognitive outcome at both 3 months (odds ratio (OR) 0.30; 95% confidence interval (CI) 0.09–0.95; p = 0.04) and 12 months (OR 0.42; 95% CI 0.18–0.97; p = 0.04) after coronary artery bypass grafting. At 5 years, the OR was 0.57 (95% CI 0.31–1.05; p = 0.07). Conclusions: In patients undergoing first-time coronary artery bypass grafting, presence of coronary collaterals is associated with a decreased risk of cognitive decline at both 3 and 12 months of follow-up. This trend persists at 5-year follow-up. Preoperative differences in the cardiac vascular condition may therefore predict cognitive outcome in patients undergoing coronary artery bypass grafting.

Key Words: Cognitive decline • Collateral circulation • Coronary artery bypass surgery