HealthDay News — Advanced age, a history of stroke, and peripheral vascular disease are the strongest predictors of stroke up to two years postoperatively for patients undergoing cardiac surgery, according to research published in the CMAJ.
“Stroke remains a devastating complication following cardiac surgery, with substantial functional and economic impact,” wrote Richard Whitlock, MD, of the Population Health Research Institute and McMaster University in Hamilton, Canada, and colleagues.
“Stroke research in cardiac surgery has focused on the immediate postoperative period; however, most patients undergoing cardiac surgery have conditions such as hypertension, diabetes and atrial fibrillation.”
To examine the incidence and predictors of long-term stroke among patients who underwent cardiac surgery, the researchers collected data from 108,711 patients who underwent cardiac surgery between 1996 and 2006 in Ontario.
Of the patients, 1.8% had a perioperative stroke and 3.6% had a stroke within two years. For both early and late stroke, the strongest predictors included advanced age (≥65 years of age; adjusted hazard ratio 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, 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, >75 years of age, 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 2 years, with similar risk factors over these periods,” wrote the investigators.