Neurological injury in patients with acute myocardial infarction undergoing operative myocardial revascularization within 48 h.

BACKGROUND

Acute myocardial infarction (AMI) is associated with an increased rate of neurological events (NE). AMI patients, who undergo coronary artery bypass graft (CABG) surgery may be at an even greater risk for peri-operative NE, but detailed data is missing.

METHODS

We conducted a retrospective, single-center data analysis of 1628 patients that underwent CABG within 48 h after being diagnosed with AMI. Between 01/2001 and 03/2023, 77 patients (4.7%) suffered from a peri-operative NE. This included 66 (4.0%) thromb-embolic strokes and 11 (0.7%) hypoxic brain damages. We compared the outcome between NE patients and those without (w/o) NE. Primary outcome parameters were 30-day mortality and long-term survival. Secondary outcome parameters included post-operative ICU length of stay, transfusion rates and need for renal replacement therapy (RRT).

RESULTS

Median time from AMI diagnosis to CABG was 7.6 h (4.4-16.4 h). Significantly more NE patients were smokers (n = 36(46.8%) vs. n = 532(34.5%);p = 0.04) and presented with a severely reduced left ventricular function pre-operatively (n = 15(20.3%) vs. n = 161(11.1%);p = 0.02). NE patients had undergone CPR pre-operatively more often than patients w/o NE (n = 23(29.9%)vs n = 168(10.8%);p < 0.001). Accordingly, EuroScore II was significantly higher in NE patients compared to patients w/o NE (7.8 (4.2-14.3) vs. 4.9 (2.8-10.2); p < 0.001). Intra-operatively, bypass-time proved to be longer in NE patients (117 (94-149) vs. 107 (88-130)minutes; p = 0.02). Post-operatively, significantly more NE patients had to stay longer than 48 h in the ICU (n = 72 (94.7%) vs. n = 866 (55.8%); p < 0.001). Neither transfusion rates nor need for RRT differed between the groups. Thirty day mortality was higher in NE patients (n = 16 (20.8%) vs. n = 165 (10.7%); p < 0.01). Pre-operative diagnosis of peripheral artery disease (pad) and need for CPR were identified as independent predictors of 30-day mortality in NE patients. Ten-year survival of NE patients remained impaired compared to patients w/o NE (39% vs. 69%; p < 0.001).

CONCLUSION

AMI Patients undergoing CABG within 48 h are at an increased risk for neurological injuries. In particular, patients with generalized atherosclerosis and those that underwent CPR pre-operatively, seem to represent a vulnerable subgroup. Further studies have to clarify whether individualized peri-operative actions may reduce the stroke rates in this setting.