Impact of Preexisting Cerebral Ischemia Detected by Magnetic Resonance Imaging and Angiography on Late Outcome After Coronary Artery Bypass Surgery

• Published in: The Annals of thoracic surgery Vol. 91; no. 3; pp. 665 - 670
• Main Authors: Matsuura, Kaoru, MD, PhD, Mogi, Kenji, MD, PhD, Sakurai, Manabu, MD, PhD, Kawamura, Tomonori, MD, Takahara, Yoshiharu, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2011; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brain Ischemia - complications; Brain Ischemia - diagnosis; Brain Ischemia - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Coronary Artery Bypass; Coronary heart disease; Diagnosis, Differential; Female; Follow-Up Studies; Heart; Humans; Japan - epidemiology; Magnetic Resonance Angiography; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Myocardial Ischemia - surgery; Neurology; Pneumology; Preoperative Care - methods; Retrospective Studies; Surgery; Survival Rate - trends; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Japan; 23; Nervous system diseases; Late; Prognosis; Cardiovascular disease; Coronary heart disease; Nuclear magnetic resonance imaging; Cerebral disorder; Vascular disease; Coronary artery bypass; Central nervous system disease; Brain ischemia; Medical imagery; Anesthesia; Circulatory system; NMR angiography; Cardiology; Cerebrovascular disease
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.10.092

Background The aim of this study was to assess the impact of preexisting ischemia detected by brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) on long-term survival, and cardiac and neurologic events after coronary artery bypass grafting (CABG). Methods Of 923 patients who underwent CABG between 1994 and 2007, 887 patients (96.1%) were followed up. Preoperative brain MRI and MRA were performed in 619 patients. Ischemia was detected by brain MRI and MRA in 158 patients (group A), but not in 461 patients (group B). Preoperative characteristics, follow-up survival, and cardiac and neurological events were investigated. Results The average follow-up period was 6.0 ± 4.3 years. Univariate analysis showed that patients in group A (68.5 ± 6.5 years) were older than those in group B (64.5 ± 8.6 years) ( p = 0.0001). Preoperative left ventricular ejection fraction was less in group A (0.516 ± 0.175) than in group B (0.556 ± 0.165) ( p = 0.02). The prevalence of peripheral vascular disease was higher in group A (14 patients: 8.9%) than in group B (11 patients: 2.4%) ( p = 0.001). The rate of on-pump CABG was lower in group A (115 patients; 72.8%) than in group B (383 patients; 83.1%) ( p = 0.007). Survival rate was significantly lower ( p = 0.062), and freedom from major adverse cardiac event or stroke were significantly lower in group A ( p = 0.0002, and p = 0.0001, respectively; log-rank test). However, the Cox proportional hazard model showed that preoperative brain ischemia detected by brain MRI and MRA affected only freedom from neurologic events ( p = 0.02; hazard ratio 2.52; 95% confidence interval 1.13 to 5.62), but not survival ( p = 0.67) or major adverse cardiac event ( p = 0.09). Conclusions Preexisting ischemic findings on brain MRI and MRA in patients who underwent CABG were related only to long-term freedom from stroke, but were not related to survival or major adverse cardiac event.