Chronologic distribution of stroke after minimally invasive versus conventional coronary artery bypass

• Published in: Journal of the American College of Cardiology Vol. 43; no. 5; pp. 752 - 756
• Main Authors: Peel, Garrett K., Stamou, Sotiris C., Dullum, Mercedes K.C., Hill, Peter C., Jablonski, Kathleen A., Bafi, Ammar S., Boyce, Steven W., Petro, Kathleen R., Corso, Paul J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 03.03.2004; Elsevier Science; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Bypasses; Cardiology; Cardiology. Vascular system; Chronic obstructive pulmonary disease; Confidence intervals; Coronary artery; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary vessels; Female; Health risks; Heart attacks; Heart surgery; Hospitals; Humans; Hypertension; Logistics; Male; Medical imaging; Medical sciences; Minimally Invasive Surgical Procedures; Multivariate Analysis; Neurology; Pathogenesis; Patients; Regression analysis; Risk analysis; Risk factors; Statistical analysis; Stroke; Stroke - epidemiology; Stroke - etiology; Studies; Surgery; Time Factors; Vascular diseases and vascular malformations of the nervous system; on-pump CABG; NNE; CABG; off-pump CABG; Nervous system diseases; Stroke; Coronary artery; Cardiovascular disease; Phlebology; Cerebral disorder; Vascular disease; Minimally invasive surgery; Treatment; Aortocoronary; Bypass; Central nervous system disease; Distribution; Circulatory system; Cardiology; Cerebrovascular disease; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2003.09.047

We sought to investigate whether the chronologic distribution of the onset of stroke occurring after coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass (off-pump CABG) is different from the conventional on-pump approach (CABG with cardiopulmonary bypass). Off-pump CABG has been associated with a lower stroke rate, compared with conventional on-pump CABG. However, it is unknown whether the chronologic distribution of the onset of stroke is different between the two approaches. We evaluated the chronologic distribution of postoperative stroke in patients undergoing CABG from June 1996 to August 2001 (n = 10,573). Preoperative risk factors for stroke were identified using the Northern New England preoperative estimate of stroke risk. Multivariate logistic regression analysis was used to determine the independent predictors of early stroke and to delineate the association between the surgical approach and the chronologic distribution of the onset of stroke. Stroke occurred in 217 patients (2%, n = 10,573). A total of 44 (20%) and 173 (80%) of these patients had stroke after off-pump CABG and on-pump CABG, respectively. The median time for the onset of stroke was two days (range 0 to 11 days) after on-pump CABG versus four days (range 0 to 14 days) after off-pump CABG (p < 0.01). On-pump CABG was associated with a higher risk of early stroke (odds ratio 5.3, 95% confidence interval 2.6 to 10.9; p < 0.01) compared with off-pump CABG. Compared with off-pump CABG, on-pump CABG is associated with an earlier onset of postoperative stroke during the recovery phase, suggesting different mechanisms in the pathogenesis of stroke between the two surgical approaches.