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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Author home page(s): Ranjit John Mehmet C. Oz Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by John, R. Articles by Oz, M. C. Search for Related Content PubMed Articles by John, R. Articles by Oz, M. C. Related Collections Cardiac - pharmacology Electrophysiology - arrhythmias Related Article

Ann Thorac Surg 2001;71:401-402
© 2001 The Society of Thoracic Surgeons

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Correspondence

Stroke after coronary artery bypass grafting: are we forgetting atrial fibrillation?: Reply

^a Department of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, Milstein Hospital, Suite 7-435, 177 Fort Washington Ave, New York, NY 10032, USA

e-mail: ranjitj{at}pol.net
e-mail: mco2{at}Columbia.edu

To the Editor

We acknowledge the importance of both pre- and postoperative atrial fibrillation on the development of stroke after coronary artery bypass grafting. It should be noted that the New York State database did not include information on the incidence of preoperative atrial fibrillation among the numerous variables. Further, as the title of our manuscript indicates, the objective of this study was to identify preoperative risk factors for stroke after coronary artery bypass grafting and not postoperative events [1] in order to develop strategies both in the pre- and intraoperative periods to reduce the incidence of this untoward event.

Several of the risk factors for stroke identified in our study such as a calcified aorta, prior stroke, increasing age, and cerebrovascular disease are reflective of progressive and advanced systemic atherosclerosis. The increased incidence of atrial fibrillation with increasing age suggests that patients with these previously mentioned risk factors have a high probability of developing atrial fibrillation. We say this not to detract on the role of atrial fibrillation on stroke but to add further to the importance of evaluating the influence of atrial fibrillation on postoperative stroke.

The incidence of stroke that Odell and colleagues mention in patients with preoperative atrial fibrillation in the CASS registry is certainly impressive. Postoperative atrial fibrillation not only increases the risk of untoward embolic phenomena including stroke, but also increases morbidity mainly from complications related to bleeding owing to the need for systemic anticoagulation. We agree with the need for prospectively performed studies commenting on not only the impact of pre- and postoperative atrial fibrillation, but also on the morbidity associated with its treatment.

References

1. John R., Choudhri A.F., Weinberg A.D., et al. Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting. Ann Thorac Surg 2000;69:30-36.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Author home page(s): Ranjit John Mehmet C. Oz Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by John, R. Articles by Oz, M. C. Search for Related Content PubMed Articles by John, R. Articles by Oz, M. C. Related Collections Cardiac - pharmacology Electrophysiology - arrhythmias Related Article