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J Thorac Cardiovasc Surg 2007;134:1121-1127
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Epidemiology of stroke after cardiac surgery in the current era

^a Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
^b Department of Neurology, Mount Sinai Medical Center, New York, NY.

Received for publication March 5, 2007; revisions received June 5, 2007; accepted for publication June 15, 2007.

^_* Address for reprints: David H. Adams, MD, Professor and Chairman, Cardiothoracic Surgery, Mount Sinai Hospital, 1190 Fifth Ave, New York, NY 10029. (Email: david.adams{at}mountsinai.org).

Objective: Previous studies of the epidemiology of stroke in patients undergoing cardiac surgery have been based primarily on patients having coronary bypass surgery and therefore have limited applicability to the more heterogenous populations seen in the current era. We examine the epidemiology of stroke after cardiac surgery in a contemporary surgical population.

Methods: Retrospective analysis was conducted of a prospective database of 5085 adults (coronary bypass 2401, isolated valve 1003, valve/coronary bypass 546, thoracic aorta 517, transplant/assist device 179, adult congenital 124, other 315) who had cardiac surgery at a single institution over a 6-year period (1998–2004).

Results: Stroke occurred in 134 (2.6%) patients. Incidence varied according to procedure (coronary bypass 1.7%, isolated valve 1.8%, valve/coronary bypass 4.4%, and ascending aorta 4.6%). Patients who had a stroke had a higher perioperative mortality rate than that of patients who did not (32.8% vs 4.9%; P < .0001) and a longer period of hospitalization (median 30 days vs 7 days; P < .0001). Multivariate logistic analysis identified 10 preoperative predictors of stroke: gender, age, aortic surgery, previous stroke, critical preoperative state, poor ventricular function, diabetes, peripheral vascular disease, unstable angina, and pulmonary hypertension. A logistic model was developed on the basis of these risk factors to predict the likelihood of stroke.

Conclusions: We have demonstrated a relatively low incidence of stroke in a diverse contemporary cardiac surgical cohort. By enabling preoperative identification of patients at risk, our logistic model has the potential to improve preoperative patient counseling and selection and could help to define high-risk cohorts for research into stroke prevention.

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