Stroke in cardiac surgical patients: Determinants and outcome

Background. Despite improving outcomes in cardiac surgical patients, stroke continues to remain a major complication. Few prospective studies are avai lable on postoperative stroke. The present study was conducted to elucidate the incidence and predictors of stroke in a large group of cardiac surgica l patients. Methods and Results. Prospective data collected on 4,941 patients undergoin g cardiac surgery were subjected to univariate and logistic regression anal yses (98.4% men; 72% older than 60 years; 9.1% with history of prior stroke ; 80.4% underwent isolated coronary artery bypass grafting). Stroke predict ors include history of stroke and hypertension, older age, systolic hyperte nsion, bronchodilator and diuretic use, high serum creatinine, surgical pri ority, great vessel repair, use of inotropic agents after cardiopulmonary b ypass, and total cardiopulmonary bypass time (p < 0.05 for all comparisons) . Median intensive care unit and hospital stays were longer, and hospital m ortality and 6-month mortality were higher for patients with stroke (p < 0. 001). Conclusions. Stroke after cardiac surgical procedures is a morbid event. Id entification of predictors and development of strategies to modify these fa ctors should lead to a lower incidence of stroke. (C) 1999 by The Society o f Thoracic Surgeons.