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Original Articles: Adult Cardiac

Temporal Pattern of Strokes After On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery

^a Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
^b Kobe City Medical Center General Hospital, Kobe, Japan
^c Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
^d Hirakata Kousai Hospital, Hirakata, Japan
^e Tenri Hospital, Tenri, Japan
^f Translational Research Center, Kyoto University Hospital, Kyoto University Graduate School of Medicine, Kyoto, Japan

Accepted for publication February 20, 2009.

^_* Address correspondence to Dr Nishiyama, Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-chou, Shogoin, Sakyo-ku, Kyoto, 606-8397, Japan (Email: keinishi{at}kuhp.kyoto-u.ac.jp).

Background: The incidence of strokes has not decreased after coronary artery bypass graft surgery (CABG). The purpose of this study is to identify incidence, risk factors, and temporal pattern of strokes after on-pump and off-pump CABG.

Methods: We analyzed 2,516 consecutive patients who underwent first elective isolated CABG. The primary endpoint was strokes within 30 days. The temporal onset of the deficits was classified by consensus as either an "early stroke," which is present just after emergence from anesthesia, or a "delayed stroke," which is present after first awaking from surgery without a neurologic deficit.

Results: More than half of strokes (29 of 46; 63%) were delayed strokes. Patients undergoing off-pump CABG had significantly lower risk of early stroke (0.1% versus 1.1%, p = 0.0009), whereas the incidence of delayed strokes was not different significantly (0.9% versus 1.4%, p = 0.3484) between patients undergoing on-pump and off-pump CABG. In multivariate analyses, undergoing off-pump CABG was an independent protective factor for all strokes (relative risk 0.29, 95% confidence interval: 0.14 to 0.56, p = 0.0005) and early strokes (relative risk 0.05, 95% confidence interval: 0.003 to 0.24, p < 0.0001), but it was not an independent protective factor for delayed strokes (relative risk 0.54, 95% confidence interval: 0.24 to 1.17, p = 0.1210).

Conclusions: Undergoing off-pump CABG reduces the incidence of perioperative stroke mainly by minimizing early strokes; however, the risk of delayed strokes is not different between patients undergoing on-pump and off-pump CABG.

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Invited Commentary

Cullen D. Morris and Ulfur T. Gudjonsson
Ann. Thorac. Surg. 2009 87: 1845. [Extract] [Full Text] [PDF]

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				C. D. Morris and U. T. Gudjonsson Invited Commentary. Ann. Thorac. Surg., June 1, 2009; 87(6): 1845 - 1845. [Full Text] [PDF]