Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener street 62, 50937 Cologne, Germany.
Department of Cardiothoracic Surgery, Helios Hospital Siegburg, Siegburg, Germany.
Perfusion. 2024 Oct;39(7):1348-1355. doi: 10.1177/02676591231193636. Epub 2023 Jul 28.
Coronary artery bypass grafting (CABG) surgery in patients with acute coronary syndrome (ACS) remains a high-risk procedure and is associated with adverse outcomes. The risk factors of acute stroke in the above-mentioned patients stay unclear and some appropriate data is lacking in the literature. Thus, we aimed to investigate the predictors of acute stroke in patients undergoing CABG surgery in ACS.
The retrospective single-centre cohort analysis was conducted. All patients ( = 1344) who suffered from acute coronary syndrome and underwent CABG procedure at the University hospital Cologne from June 2011 until October 2019 were included in our study. In order to find the risk factors of acute stroke after bypass surgery, patients were divided into two groups (non-stroke group ( = 1297) and stroke group ( = 47)). In order to even above-mentioned groups propensity score matching (PSM) analysis was performed (non-stroke group ( = 46) and stroke group ( = 46).
Duration of cardiopulmonary bypass ( = .015) and cross clamp time ( = .006) were significantly longer in patients who suffered stroke. Perioperative myocardial infarction was significantly higher ( = .030) in the stroke group. Likewise, the duration of intensive care unit stay ( < .001) and in-hospital stay ( < .001) were significantly longer in patients with stroke. However, the mortality rate did not differ significantly ( = .131) between above-mentioned groups. Univariate and multivariate analysis showed cardiogenic shock ( = .003), peripheral vascular disease (PVD, = .025) and previous stroke ( = .045) as relevant independent predictors for acute stroke after CABG procedure in patients with ACS.
Based on our findings, acute stroke after bypass surgery in patients with ACS is associated with increased mortality and adverse outcomes. Cardiogenic shock, peripheral vascular disease and previous stroke were independent predictors of stroke after CABG procedure. Therefore, preoperative evaluation of potential risk factors may be crucial to improve postoperative results.
急性冠状动脉综合征（ACS）患者行冠状动脉旁路移植术（CABG）仍然是一种高风险的手术，与不良结局相关。上述患者发生急性脑卒中的危险因素尚不清楚，文献中缺乏一些合适的数据。因此，我们旨在探讨 ACS 患者行 CABG 术后发生急性脑卒中的预测因素。
回顾性单中心队列分析。纳入 2011 年 6 月至 2019 年 10 月在德国科隆大学医院因 ACS 接受 CABG 手术的所有患者（n=1344）。为了寻找旁路手术后发生急性脑卒中的危险因素，将患者分为两组（非脑卒中组（n=1297）和脑卒中组（n=47））。为了平衡上述两组，进行了倾向评分匹配（PSM）分析（非脑卒中组（n=46）和脑卒中组（n=46））。
脑卒中患者的体外循环时间（ =.015）和主动脉阻断时间（ =.006）明显延长。脑卒中组围手术期心肌梗死发生率明显较高（ =.030）。同样，脑卒中患者的 ICU 住院时间（ <.001）和住院时间（ <.001）明显延长。然而，两组死亡率差异无统计学意义（ =.131）。单因素和多因素分析显示，心源性休克（ =.003）、外周血管疾病（PVD， =.025）和既往脑卒中（ =.045）是 ACS 患者 CABG 术后发生急性脑卒中的独立相关预测因素。
基于我们的发现，ACS 患者旁路手术后发生急性脑卒中与死亡率增加和不良结局相关。心源性休克、外周血管疾病和既往脑卒中是 CABG 术后发生脑卒中的独立预测因素。因此，术前评估潜在危险因素可能对改善术后结果至关重要。
