Adverse cerebral outcomes after coronary bypass surgery

Gary W. Roach, Marc Kanchuger, Christina Mora Mangano, Mark Newman, Nancy Nussmeier, Richard Wolman, Anil Aggarwal, Katherine Marschall, Steven H. Graham, Catherine Ley, Gerard Ozanne, Dennis T. Mangano

Research output: Contribution to journalArticlepeer-review

1710 Scopus citations


Background: Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of - and the use of resources associated with - perioperative adverse neurologic events, including cerebral injury. Methods: In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). Results: Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adverse cerebral outcome; P<0.001 for all comparisons), longer hospitalization (25 days with type I outcomes, 21 days with type II, and 10 days with no adverse outcome; P<0.001), and a higher rate of discharge to facilities for intermediate- or long-term care (47 percent, 30 percent, and 8 percent; P<0.001). Predictors of type I outcomes were proximal aortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol. Conclusions: Adverse cerebral outcomes after coronary bypass surgery are relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of intermediate- or long-term care facilities. New diagnostic and therapeutic strategies must be developed to lessen such injury.

Original languageEnglish
Pages (from-to)1857-1863
Number of pages7
JournalNew England Journal of Medicine
Issue number25
StatePublished - Dec 19 1996

ASJC Scopus subject areas

  • General Medicine


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