Predictors and outcomes of minor cerebrovascular events after cardiac surgery: a multivariable analysis of 1346 patients.

AIM: There are no extensive data exist regarding the epidemiology and prognosis of minor cerebrovascular events (MCVE) in adults after cardiac surgery. The aim of this study was to determine perioperative predictors of MCVE and impact on postoperative outcomes after cardiac surgery.

METHODS

The database of 1346 adult patients between June 2004-May 2011 were retrospectively analyzed to determine risk factors for postoperative MCVE and prognostic impact in our instution. MCVE was defined as ''a new focal neurologic deficit which appears in the postoperative period''. Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, and discharge status by univariate analyses. Then multivariate logistic regression with forward elimination determined six important denominators of the 24 factors examined on univariate analysis for MCVE.

RESULTS

Twenty-six patients suffered a postoperative minor stroke (2%) at a median of 24 hours postoperatively. Head computed tomography was performed in 19 patients (73%) of whom ischemic stroke were identified in 4 (21.05%) patients and pituitary macroadenoma was diagnosed in one patient treated with surgery. Patients who experienced MCVE had no operative mortality and were discharged without any neurological deficit. Multivariable logistic regression analysis identified six risk factors for MCVE: unstable angina pectoris, hyperlipidemia, cerebrovascular accident within two years, EF<50, intra-aortic balloon counterpulsation and higher Euroscore values.

CONCLUSION

Unstable angina pectoris, hyperlipidemia, cerebrovascular accident within last two years, EF<50, intra-aortic balon counterpulsation and higher Euroscore values in adults after cardiac surgery are independent predictors of minor stroke as compared with similar predictors of major stroke.