Predictors Identified for Stroke Post-Cardiac Surgery
Strongest predictors include advanced age, history of stroke or TIA, peripheral vascular disease
THURSDAY, July 24, 2014 (HealthDay News) -- For patients undergoing cardiac surgery, the strongest predictors of stroke up to two years postoperatively include advanced age, history of stroke, and peripheral vascular disease, according to a study published online July 21 in CMAJ, the journal of the Canadian Medical Association.
Richard Whitlock, M.D., from the Population Health Research Institute and McMaster University in Hamilton, Canada, and colleagues examined the incidence and predictors of long-term stroke among patients who underwent cardiac surgery. The cohort included 108,711 patients who underwent cardiac surgery between 1996 and 2006 in Ontario.
The researchers found that 1.8 percent of participants had a perioperative stroke and 3.6 percent had a stroke within two years. For both early and late stroke, the strongest predictors included advanced age (≥65 years; adjusted hazard ratio [aHR] for all stroke, 1.9); history of stroke or transient ischemic attack (aHR, 2.1); peripheral vascular disease (aHR, 1.6); combined coronary bypass grafting and valve surgery (aHR, 1.7); and valve surgery alone (aHR, 1.4). Predictors of early stroke only were preoperative need for dialysis (adjusted odds ratio [aOR], 2.1) and new-onset postoperative atrial fibrillation (aOR, 1.5). The risk of stroke or death was increased with a CHADS2 (congestive heart failure, hypertension, age >75, diabetes mellitus, and prior stroke or transient ischemic attack) score of 2 or higher versus 0 or 1.
"Patients who had cardiac surgery were at highest risk of stroke in the early postoperative period and had continued risk over the ensuing two years, with similar risk factors over these periods," the authors write.