Albacker Turki B, Alhothali Abdulaziz M, Alhomeidan Majid, Arafat Amr A, Algarni Khaled D, Eldemerdash Ahmed, Bakir Bakir
Cardiac Sciences Department, College of Medicine, King Fahad Cardiac Centre, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Radiology Department, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Quant Imaging Med Surg. 2023 Apr 1;13(4):2507-2513. doi: 10.21037/qims-22-1047. Epub 2023 Feb 10.
Stroke is one of the most feared complications post coronary artery bypass with aortic calcifications being the commonest source of embolic stroke. The aim of our study was to determine the clinical impact and usefulness of routine use of plain chest computerised tomography to screen for aortic calcification on incidence of postoperative stroke in coronary artery bypass grafting (CABG) patients.
This is a retrospective case-control study that included four hundred and five patients who underwent primary isolated CABG and had preoperative plain chest computerised tomography as a screening for aortic calcification. Aortic calcification was classified according to the area involved (ascending, arch, arch vessels and descending aorta) and the pattern of calcification. Patients were divided into two groups according to the incidence of postoperative stroke and the aortic calcification distribution was compared between the two groups. Stroke predictors were studies using univariate and multivariate regression analysis.
Fourteen patients (3.5%) developed postoperative stroke. There was no difference in preoperative and operative characteristics between patients who developed postoperative stroke and those who did not, except for the history of preoperative stroke or transient ischemic attack (TIA) that was higher in the group who developed postoperative stroke (50.00% 6.19%, P<0.001). Patients who developed postoperative stroke had higher percentage of aortic root calcification (78.57% 64.18%), ascending aortic calcification (28.57% 19.07%) and descending aortic calcification (85.71% 73.71%) but none of them reached statistical significance. History of preoperative stroke or TIA was the only significant predictor of postoperative stroke using both univariate and multivariate regression models.
Our study showed the importance of preoperative computed tomography (CT) scan of the chest as a screening tool as it detected a high prevalence of aortic calcification in our patients. However, its impact on prevention of postoperative stroke needs to be investigated further in future prospective studies.
中风是冠状动脉搭桥术后最令人担忧的并发症之一，主动脉钙化是栓塞性中风最常见的来源。我们研究的目的是确定常规胸部平扫计算机断层扫描筛查主动脉钙化对冠状动脉搭桥术（CABG）患者术后中风发生率的临床影响及实用性。
这是一项回顾性病例对照研究，纳入了405例行初次单纯CABG且术前行胸部平扫计算机断层扫描以筛查主动脉钙化的患者。根据受累区域（升主动脉、主动脉弓、主动脉弓血管和降主动脉）及钙化模式对主动脉钙化进行分类。根据术后中风发生率将患者分为两组，并比较两组间主动脉钙化分布情况。采用单因素和多因素回归分析研究中风预测因素。
14例患者（3.5%）发生术后中风。发生术后中风的患者与未发生术后中风的患者在术前和手术特征方面无差异，但术后中风组术前中风或短暂性脑缺血发作（TIA）病史发生率更高（50.00%对6.19%，P<0.001）。发生术后中风的患者主动脉根部钙化百分比（78.57%对64.18%）、升主动脉钙化百分比（28.57%对19.07%）和降主动脉钙化百分比（85.71%对73.71%）更高，但均未达到统计学意义。术前中风或TIA病史是单因素和多因素回归模型中术后中风的唯一显著预测因素。
我们的研究表明术前胸部计算机断层扫描（CT）作为筛查工具的重要性，因为它在我们的患者中检测到主动脉钙化的高患病率。然而，其对预防术后中风的影响需要在未来的前瞻性研究中进一步探讨。
