Adverse cerebral outcomes after coronary bypass surgery

被引:1392
作者
Roach, GW
Kanchuger, M
Mangano, CM
Newman, M
Nussmeier, N
Wolman, R
Aggarwal, A
Marschall, K
Graham, SH
Ley, C
Ozanne, G
Mangano, DT
机构
[1] ISCHEMIA RES & EDUC FDN, SAN FRANCISCO, CA 94143 USA
[2] KAISER PERMANENTE MED CTR, SAN FRANCISCO, CA USA
[3] NYU, NEW YORK, NY USA
[4] STANFORD UNIV, STANFORD, CA USA
[5] DUKE UNIV, DURHAM, NC USA
[6] MERCY MED CTR, REDDING, CA USA
[7] VIRGINIA COMMONWEALTH UNIV, MED COLL VIRGINIA, RICHMOND, VA 23298 USA
[8] VET AFFAIRS MED CTR, MILWAUKEE, WI USA
[9] UNIV PITTSBURGH, PITTSBURGH, PA USA
[10] VET AFFAIRS MED CTR, SAN FRANCISCO, CA 94121 USA
关键词
D O I
10.1056/NEJM199612193352501
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of - and the use of resources associated with - perioperative adverse neurologic events, including cerebral injury. Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P<0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P<0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (47 percent, 30 percent, and 8 percent; P<0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol. Conclusions Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or Iong-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury.
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收藏
页码:1857 / 1863
页数:7
相关论文
共 49 条
[1]  
ACINAPURA AJ, 1988, CIRCULATION, V78, P179
[2]   HYPERTENSION AND RISK OF STROKE RECURRENCE [J].
ALTER, M ;
FRIDAY, G ;
LAI, SM ;
OCONNELL, J ;
SOBEL, E .
STROKE, 1994, 25 (08) :1605-1610
[3]   SINGLE-CLAMP TECHNIQUE - AN IMPORTANT ADJUNCT TO MYOCARDIAL AND CEREBRAL PROTECTION IN CORONARY OPERATIONS [J].
ARANKI, SF ;
RIZZO, RJ ;
ADAMS, DH ;
COUPER, GS ;
KINCHLA, NM ;
GILDEA, JS ;
COHN, LH .
ANNALS OF THORACIC SURGERY, 1994, 58 (02) :296-303
[4]  
BAREL Y, 1992, J THORAC CARDIOV SUR, V104, P469
[6]   CENTRAL NERVOUS-SYSTEM COMPLICATIONS OF CORONARY-ARTERY BYPASS GRAFT-SURGERY - PROSPECTIVE ANALYSIS OF 421 PATIENTS [J].
BREUER, AC ;
FURLAN, AJ ;
HANSON, MR ;
LEDERMAN, RJ ;
LOOP, FD ;
COSGROVE, DM ;
GREENSTREET, RL ;
ESTAFANOUS, FG .
STROKE, 1983, 14 (05) :682-687
[7]  
Bull D A, 1993, Cardiovasc Surg, V1, P182
[8]   Calculating risk and outcome: The society of thoracic surgeons database [J].
Clark, RE .
ANNALS OF THORACIC SURGERY, 1996, 62 (05) :S2-S5
[9]   MICROEMBOLI DURING CORONARY-ARTERY BYPASS-GRAFTING - GENESIS AND EFFECT AN OUTCOME [J].
CLARK, RE ;
BRILLMAN, J ;
DAVIS, DA ;
LOVELL, MR ;
PRICE, TRP ;
MAGOVERN, GJ .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1995, 109 (02) :249-258
[10]  
DAVILAROMAN VG, 1991, CIRCULATION, V84, P47