Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Newcastle, UK.
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Int J Clin Pract. 2021 May;75(5):e14067. doi: 10.1111/ijcp.14067. Epub 2021 Feb 6.
Data on the incidence and outcomes of ischemic stroke in patients undergoing coronary artery bypass grafting (CABG) in the current era are limited. The goal of this study was to examine contemporary trends, predictors, and outcomes of ischemic stroke following CABG in a large nationally representative database over a 12-year-period.
The National Inpatient Sample was used to identify all adult (≥18 years) patients who underwent CABG between 2004 and 2015. The incidence and predictors of post-CABG ischemic stroke were assessed and in-hospital outcomes of patients with and without post-CABG stroke were compared.
Out of 2 569 597 CABG operations, ischemic stroke occurred in 47 279 (1.8%) patients, with a rising incidence from 2004 (1.2%) to 2015 (2.3%) (P < .001). Patient risk profiles increased over time in both cohorts, with higher Charlson comorbidity scores observed amongst stroke patients. Stroke was independently associated with higher rates of in-hospital mortality (3-fold), longer lengths of hospital stay (6 more days), and higher total hospitalisation cost ($80 000 more). Age ≥60 years and female sex (OR 1.33, 95% CI 1.31-1.36) were the strongest predictors of stroke (both P < .001). Further, on-pump CABG was not an independent predictor of stroke (P = .784).
In this nationally representative study we have shown that the rates of postoperative stroke complications following CABG have increased over time to commensurate with a parallel increase in overall baseline patient risks. Given the adverse impact of stroke on in-hospital morbidity and mortality after CABG, further studies are warranted to systematically delineate factors contributing to this striking trend.
目前关于在冠状动脉旁路移植术（CABG）中发生缺血性卒中的发病率和结局的数据有限。本研究的目的是在一个长达 12 年的时间内，在一个大型全国代表性数据库中检查当代 CABG 后缺血性卒中的趋势、预测因素和结局。
使用国家住院患者样本（National Inpatient Sample）确定 2004 年至 2015 年间进行 CABG 的所有成年（≥18 岁）患者。评估了 CABG 后缺血性卒中的发生率和预测因素，并比较了有和无 CABG 后卒中患者的住院期间结局。
在 2569597 例 CABG 手术中，有 47279 例（1.8%）发生了缺血性卒中，发生率从 2004 年的 1.2%上升到 2015 年的 2.3%（P<0.001）。两个队列的患者风险概况都随时间而增加，卒中患者的 Charlson 合并症评分更高。卒中与更高的住院期间死亡率（3 倍）、更长的住院时间（约 6 天）和更高的总住院费用（约 80000 美元）独立相关。年龄≥60 岁和女性（OR 1.33，95%CI 1.31-1.36）是卒中的最强预测因素（均 P<0.001）。此外，体外循环 CABG 不是卒中的独立预测因素（P=0.784）。
在这项具有全国代表性的研究中，我们发现 CABG 后手术并发症性卒中的发生率随时间推移而增加，与总体基线患者风险的平行增加相符。鉴于卒中对 CABG 后住院发病率和死亡率的不良影响，需要进一步研究以系统地确定导致这一显著趋势的因素。
