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The Annals of Thoracic Surgery, Vol 40, 574-581, Copyright © 1985 by The Society of Thoracic Surgeons
TJ Gardner, PJ Horneffer, TA Manolio, TA Pearson, VL Gott, WA Baumgartner, AM Borkon, L Watkins Jr and BA Reitz
To identify possible risk factors for the occurrence of stroke during
coronary artery bypass grafting (CABG), the cases of 3,279 consecutive
patients having isolated CABG from 1974 to 1983 were reviewed. During this
period, the risk of death fell from 3.9% to 2.6%. The stroke rate, however,
fell initially but then rose from 0.57% in 1979 to 2.4% in 1983. Adjustment
of these data for age clearly demonstrated that the risk of stroke has
increased largely because of an increase in the mean age of patients
undergoing CABG procedures. A case-control study involving all 56 stroke
victims and 112 control patients was used to identify those risk factors
significantly associated with the development of stroke in univariate
analysis: increased age (63 versus 57 years in stroke patients and
controls, respectively; p less than 0.0001); preexisting cerebrovascular
disease (20% versus 8%; p less than 0.03); severe atherosclerosis of the
ascending aorta (14% versus 3%; p less than 0.005); protracted
cardiopulmonary bypass time (122 minutes versus 105 minutes; p less than
0.005); and severe perioperative hypotension (23% versus 4%; p less than
0.0001). Other variables not found to correlate with postoperative stroke
included previous myocardial infarction, hypertension, diabetes mellitus,
lower extremity vascular disease, preoperative left ventricular function,
and intraoperative perfusion techniques. Elderly patients who have
preexisting cerebrovascular disease or severe atherosclerosis of the
ascending aorta or who require extensive revascularization procedures have
a significantly increased risk of postoperative stroke.
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