Impact of preoperative neurologic events on outcomes after coronary artery bypass grafting.

BACKGROUND: Neurologic events (permanent stroke and transient events) can be devastating complications after coronary artery bypass grafting (CABG). This study assessed the impact of a history of preoperative neurologic events on postoperative outcomes in patients undergoing off-pump coronary artery bypass (OPCAB) vs conventional coronary artery bypass (CCAB).

METHODS: From January 1996 to June 2006, 14,278 patients underwent primary, isolated CABG (5641 OPCAB and 8637 CCAB) at Emory Healthcare Hospitals and were prospectively entered into a computerized database. In a multiple logistic regression analysis using propensity score adjustment, we evaluated the impact of preoperative neurologic events on in-hospital mortality and postoperative neurologic events in patients undergoing OPCAB vs CCAB using adjusted odds ratios (AOR).

RESULTS: Overall, postoperative neurologic events occurred in 1.9% (274 of 14,278) of patients and were associated with an in-hospital mortality of 13.5% (37 of 274). In the logistic regression analysis, patients with preoperative neurologic events had a higher incidence of postoperative neurologic events (AOR, 3.07; p < 0.0001) and in-hospital mortality (AOR, 2.19; p < 0.0001). The OPCAB patients were less likely to have postoperative neurologic events compared with CCAB patients (AOR, 0.49; p < 0.001). However, no significant interaction existed between preoperative neurologic events and operation type for any of the postoperative comparisons.

CONCLUSIONS: Preoperative neurologic events are risk factors for postoperative neurologic events and in-hospital mortality. OPCAB is associated with a reduced risk of postoperative neurologic events compared with CCAB. However, OPCAB does not confer additional risk reduction in patients with preoperative neurologic events.