RISK-FACTORS FOR STROKE IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-GRAFTING

Objective: To determine predictors of stroke in patients undergoing fi rst-time coronary bypass grafting, we prospectively collected data on 1631 consecutive patients, Methods: Patients with a history of stroke and/or central nervous system symptoms (n = 134) and/or carotid bruits (n = 95) underwent carotid Doppler evaluation, Stenosis greater than 70% was considered significant, Patients with symptomatic disease or a symptomatic bilateral disease were referred for combined coronary bypa ss and carotid endarterectomy (It = 21), Patients with neurologic symp toms after the operation were assessed by a neurologist and underwent a computed tomographic scan, Events were classified as reversible tran sient ischemic attack, reversible ischemic neurologic deficit, or irre versible stroke, Results: There were 19 strokes (1.2%) and 20 deaths ( 1.2%) in this series, In patients with carotid screening, risk of stro ke increased with severity of carotid disease and ranged from 0% in pa tients without stenosis, to 3.2% (1/31) in those with greater than 70% stenosis, and to 27.3% (6/22) in those with carotid occlusion, BS ste pwise logistic regression analysis six variables were identified as ri sk factors for stroke, The most important predictor was carotid occlus ion Kith or without contralateral stenosis (odds ratio = 28, 95% confi dence interval (8,105), In this group, four of five strokes occurred o n the occluded side, Other risk factors were presence of ascending aor tic disease at the time of surgery (odds ratio = 12.8, confidence inte rval 3,48), perioperative myocardial infarction (odds ratio = 8.2, con fidence interval 2,33), poor left ventricular function (odds ratio = 4 .6, confidence interval 1,19), peripheral vascular disease (odds ratio = 3.2, confidence interval 1,9), and age >60 Sears (odds ratio = 2.9, confidence interval 0.8,11), Conclusion: We conclude that risk factor s for perioperative stroke in patients undergoing coronary artery bypa ss grafting are multiple, Carotid scanning in patients with neurologic symptoms or carotid bruits can identify patients at increased risk Pa tients with carotid occlusion are at high risk for stroke on the occlu ded side.