This study assesses demographic and clinical variables associated with perioperative
and late stroke in diabetes mellitus patients after multivessel coronary artery bypass
grafting (CABG). Future Revascularization Evaluation in Patients with Diabetes Mellitus:
Optimal Management of Multivessel Disease (FREEDOM) is the largest randomized trial
of diabetic patients undergoing multivessel CABG. FREEDOM patients had improved survival
free of death, myocardial infarction, or stroke and increased overall survival after
CABG compared to percutaneous intervention. However, the stroke rate was greater following
CABG than percutaneous intervention. We studied predictors of stroke in CABG-treated
patients analyzing separately overall, perioperative (≤30 days after surgery), and
late (>30 days after surgery) stroke. For long-term outcomes (overall stroke and late
stroke), Cox proportional hazards regression was used, accounting for time to event,
and logistic regression was used for perioperative stroke. Independent perioperative
stroke predictors were previous stroke (odds ratio [OR] 6.96, 95% confidence interval
[CI] 1.43 to 33.96; p = 0.02), warfarin use (OR 10.26, 95% CI 1.10 to 96.03; p = 0.02),
and surgery outside the United States or Canada (OR 9.81, 95% CI 1.28 to 75.40; p =
0.03). Independent late stroke predictors: renal insufficiency (hazard ratio [HR]
3.57, 95% CI 1.01 to 12.64; p = 0.048), baseline low-density lipoprotein ≥105 mg/dl
(HR 3.28, 95% CI 1.19 to 9.02; p = 0.02), and baseline diastolic blood pressure (each
1 mm Hg increase reduces stroke hazard by 5%; HR 0.95, 95% CI 0.91 to 0.99; p = 0.03).
There was no overlap between predictors of perioperative versus late stroke. In conclusion,
late post-CABG strokes were associated with well-described risk factors. Nearly half
of the strokes were perioperative. Independent risk factors for perioperative stroke:
previous stroke, previous warfarin use, and CABG performed outside the United States
or Canada.
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Article info
Publication history
Published online: February 20, 2015
Accepted:
February 11,
2015
Received in revised form:
February 11,
2015
Received:
October 31,
2014
Footnotes
See page 1388 for disclosure information.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
