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G. Hossein Almassi
Martin J. London
Gulshan K. Sethi
Frederick L. Grover
Karl E. Hammermeister
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Ann Thorac Surg 1999;68:391-397
© 1999 The Society of Thoracic Surgeons

Original Articles

Stroke in cardiac surgical patients: determinants and outcome

G. Hossein Almassi, MDa,b, Tracy Sommers, RNa, Thomas E. Moritz, MSc, A. Laurie W. Shroyer, PhDd, Martin J. London, MDd, William G. Henderson, PhDc, Gulshan K. Sethi, MDe, Frederick L. Grover, MDd, Karl E. Hammermeister, MDd

a Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
b Medical College of Wisconsin, Milwaukee, Wisconsin, USA
c VA Medical Center at Hines, Illinois, USA
d VA Medical Center, Denver, Colorado, USA
e VA Medical Center, Tucson, Arizona, USA

Address reprint requests to Dr Almassi, Division of Cardiothoracic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave, PO Box 26099, Milwaukee, WI 53226
e-mail: galmassi{at}mcw.edu

Presented at the Forty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, November 12–14, 1998.

Background. Despite improving outcomes in cardiac surgical patients, stroke continues to remain a major complication. Few prospective studies are available on postoperative stroke. The present study was conducted to elucidate the incidence and predictors of stroke in a large group of cardiac surgical patients.

Methods and Results. Prospective data collected on 4,941 patients undergoing cardiac surgery were subjected to univariate and logistic regression analyses (98.4% men; 72% older than 60 years; 9.1% with history of prior stroke; 80.4% underwent isolated coronary artery bypass grafting). Stroke predictors include history of stroke and hypertension, older age, systolic hypertension, bronchodilator and diuretic use, high serum creatinine, surgical priority, great vessel repair, use of inotropic agents after cardiopulmonary bypass, and total cardiopulmonary bypass time (p < 0.05 for all comparisons). Median intensive care unit and hospital stays were longer, and hospital mortality and 6-month mortality were higher for patients with stroke (p < 0.001).

Conclusions. Stroke after cardiac surgical procedures is a morbid event. Identification of predictors and development of strategies to modify these factors should lead to a lower incidence of stroke.


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