Abstract 14932: Long-term Incidence of Stroke and Transient Ischemic Attack after Coronary Artery Bypass Grafting
Introduction: Stroke and transient ischemic attack (TIA) after cardiac surgery are important concerns for both short term and long term disability, which is associated with increased medical costs and decreased cognitive function and quality of life.
Hypothesis: This study aims to examine the epidemiology, risk factors and healthcare burden of new-onset stroke and TIA during the long term following coronary artery bypass grafting (CABG).
Methods: All 9,172 consecutive patients who underwent isolated CABG and discharged alive between January 1999 and December 2008 were included and analyzed for long-term new-onset stroke and TIA after the procedure. Patients were defined with stroke or TIA, according to the definitions of the 2013 American Heart Association criteria. Predictors of stroke and TIA were determined by developing a multivariate regression model.
Results: After an average of 3.7 years of follow-up, the prevalence of new-onset ischemic stroke, hemorrhagic stroke, undetermined stroke and TIA was 5.6%, 0.3%, 0.5% and 2.3%, respectively. The prevalence of stroke or TIA was 2.2%, 4.9%, 9.7%, 14.4% and 18.1% at 1 year, 3 years, 5 years, 8 years and 10 years after the CABG. The relative risks of myocardial infarction was 4.33 (95% CI 2.68-6.99) for patients developed new-onset stroke or TIA. Among patients who developed stroke and TIA, 78.8% of them experienced at least once repeat hospitalization. Following adjustment for patient and surgical characteristics, preoperative atrial fibrillation (hazard ratio [HR]=1.48; 95% CI, 1.01-2.16), insufficient physical activity (HR=1.72; 95% CI, 1.41-2.11) and underuse of β-blockers (HR=1.20; 95% CI, 1.04-1.39) were independently associated with significantly higher risk of suffering new-onset stroke and TIA after CABG. At 3 years after CABG, costs for patients who developed stroke were 22,778 RMB (approximately US$3,282) higher than for those who did not (p<0.001).
Conclusions: Morbidity combined with the significant incremental costs attributed to the postoperative stroke and TIA was high after CABG. Reasonable prevention strategies should be designed to attenuate the healthcare burden of new-onset stroke and TIA following the primary procedure.
Author Disclosures: H. Zhang: None. X. Yuan: None. Y. Zhao: None. C. Rao: None. W. Wang: None. S. Hu: None. Z. Zheng: None.
- © 2014 by American Heart Association, Inc.