Early and late prognostic significance of remote and reversible preoperative neurological events in patients undergoing coronary artery bypass grafting

Objectives: Preoperative neurological event with functional impairment is high risk for operative morbidity and mortality after coronary artery bypass grafting (CABG). However, data regarding the influence of remote and reversible neurological events on early and late survival are lacking. Methods: The clinical profile and operative outcome of 5542 patients who underwent first-time CABG from 01 April 1999 through 30 June 2008 were analysed. Late survival data were 100% complete. The relationship between preoperative neurological event and survival (early and late) was investigated using multivariate logistic regression and survival analyses. Results: Mean age was 65.2 +/- 9.2 years, and 494 patients (8.9%) had remote reversible neurological events preoperatively. There were 129 (2.3%) operative and 595 (10.7%) late deaths after a mean follow-up of 4.9 +/- 2.7 years. Reversible neurological events had strong univariate (odds ratio (OR) 2.80, 95% confidence interval (CI) 1.82-4.33, p < 0.0001) and multivariate associations (OR 2.14, 95% CI 1.34-3.41, p = 0.001) with operative mortality. Although reversible neurological events exhibited a powerful univariate relationship with late deaths (hazard ratio (HR) 1.66, 95% CI 1.30-2.12, p < 0.0001), this was not maintained after controlling for other factors in multivariable analysis (HR 1.24, 95% CI 0.97-1.59, p = 0.08). Neurological complications, more frequent in patients with preoperative events, were implicated in 25% of operative deaths in patients with preoperative neurological events. The respective 5- and 10-year survival rates for patients with reversible neurological events (86% and 68%) were substantially lower than others (91% and 80%, p < 0.0001). Conclusions: Remote reversible neurological events increase the risk of fatal and non-fatal postoperative neurological complications. Rigorous measures to improve cerebral protection are warranted in these patients. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.