Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting

Background. Stroke complicates the postoperative course in 1% to 6% of pati ents undergoing coronary revascularization. There has been no large scale m andatory database reporting on the incidence of stroke after coronary revas cularization. Methods. A multicenter regional database from the Bureau of Health Care Res earch Information Services, New York State Department of Health, on 19,224 patients who underwent coronary revascularization in 31 hospitals within Ne w York State during 1995 was analyzed to determine the risk factors for pos toperative stroke. Results. The incidence of postoperative stroke was 1.4% (n = 270). Hospital mortality for patients who had a stroke was 24.8%, compared with 2.0% for the rest of the patient population. Postoperative stroke increased the hosp ital length of stay threefold (27.9 +/- 1.9 versus 9.1 +/- 0.9 days, p < 0. 0001). Multivariable logistic regression identified the following variables to be significantly associated with a postoperative stroke: calcified aort a (P < 0.0001; odds ratio [OR], 3.013), prior stroke (p 0.0003; OR, 1.909), age (p < 0.0001; OR, 1.522 per 10 years), carotid arterial disease (p = 0. 002; OR, 1.590), duration of cardiopulmonary bypass (p = 0.0004; OR, 1.27 p er 60 minutes), renal failure ((p = 0.0062; OR, 2.032), peripheral vascular disease (p = 0.0157; OR, 1.62), cigarette smoking (p = 0.0197; ORI 1.621), and diabetes mellitus (p = 0.0158; on, 1.373). Conclusions. Postoperative stroke increases mortality and length of stay af ter coronary revascularization. Several risk factors can be identified, and some of these factors are potentially amenable to intervention, either bef ore or during coronary revascularization, and should also influence patient selection. (C) 2000 by The Society of Thoracic Surgeons.