Abstract 13698: Relationship Between the Carotid Atherosclerotic Burden Score and Stroke in the Postoperative of Myocardial Revascularization Surgery and/or Aortic Valve Replacement
Background: Prior studies have shown an association between atherosclerotic burden and vascular events, as well as the relationship among severe carotid obstruction and stroke, in patients undergoing cardiac surgery. The association between carotid atherosclerosis burden and cerebrovascular events after postoperative cardiac surgery is unknown. Purposes. To assess the relationship between carotid atherosclerosis burden, as a possible marker of aortic atherosclerotic plaque, and the occurrence of stroke in patients undergoing isolated coronary bypass surgery(CABG) and/or aortic valve replacement(AVR).
Methods: 1974 consecutive patients(pts), undergoing CABG surgery and/or AVR were enrolled in a retrospective study from 01/2003 to 12/2009. Doppler ultrasound of the carotid arteries was performed within 30 days prior to surgery. Pts<50 year or with a previous carotid procedure were excluded. A multiple logistic regression model was developed to estimate the carotid atherosclerotic burden score (ABS). Points (p) were determined by corresponding probabilities of stroke occurrence: normal: 0 p; isolated common carotid plaque: 1 p; isolated internal carotid plaque: 1.6 p; diffuse common carotid plaque: 2.7 p; diffuse internal carotid plaque: 3 p. The resulting score was the sum of the arteries of both sides.
Results: 70 pts(3.54%) suffered a postoperative stroke. This group included elderly pts(70.67 vs. 68.88 years,p=0.026) and had a higher incidence of combined surgeries(35.7% vs. 18.5%,p<0.001). There were no significant differences in percentage of carotid obstruction and preoperative risk scores. The mean values of ABS were significantly different among pts with postoperative stroke and those without(5.35 vs. 4.03 p,p=0.006). In a multiple logistic regression analysis, ABS was the only significant independent predictor of stroke (OR 1.16,95% CI:1.05–1.27;p=0.001). ROC analysis showed that a cut-off value greater than 3.2 points had a sensitivity of 87.1% for stroke (95% CI:75–93.3), with a ROC area of 0.58(95% CI: 0.56–0.61;p=0.03).
Conclusions: The ABS showed association with occurrence of postoperative stroke in CABG surgery and/or AVR. A score higher than 3.2 points identified a group of pts with an increased risk of event.
- © 2010 by American Heart Association, Inc.