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Predictors of Stroke Associated With Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease

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 Disea... Full description

Journal Title: The American journal of cardiology 2015, Vol.115 (10), p.1382-1388
Main Author: Domanski, Michael J., MD
Other Authors: Farkouh, Michael E., MD , Zak, Victor, PhD , Feske, Steven, MD , Easton, Donald, MD , Weinberger, Jesse, MD , Hamon, Martial, MD , Escobedo, Jorge, MD, MSc , Shrader, Peter, MA , Siami, Flora S., MPH , Fuster, Valentin, MD, PhD
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: United States: Elsevier Inc
ID: ISSN: 0002-9149
Link: https://www.ncbi.nlm.nih.gov/pubmed/25824543
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title: Predictors of Stroke Associated With Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease
format: Article
creator:
  • Domanski, Michael J., MD
  • Farkouh, Michael E., MD
  • Zak, Victor, PhD
  • Feske, Steven, MD
  • Easton, Donald, MD
  • Weinberger, Jesse, MD
  • Hamon, Martial, MD
  • Escobedo, Jorge, MD, MSc
  • Shrader, Peter, MA
  • Siami, Flora S., MPH
  • Fuster, Valentin, MD, PhD
subjects:
  • Abridged Index Medicus
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis
  • Anticoagulants (Medicine)
  • Blood pressure
  • Cardiovascular
  • Cardiovascular disease
  • Care and treatment
  • Confidence intervals
  • Coronary artery bypass
  • Coronary Artery Bypass - adverse effects
  • Coronary Artery Disease - complications
  • Coronary Artery Disease - diagnosis
  • Coronary Artery Disease - surgery
  • Coronary heart disease
  • Coronary vessels
  • Diabetes
  • Diabetes Mellitus
  • Diabetics
  • Family medical history
  • Female
  • Follow-Up Studies
  • Global Health
  • Heart attacks
  • Heart surgery
  • Hemorrhage
  • Humans
  • Incidence
  • Low density lipoproteins
  • Male
  • Medical colleges
  • Middle Aged
  • Mortality
  • Multivariate analysis
  • Plants
  • Postoperative Complications
  • Prognosis
  • Retrospective Studies
  • Risk Assessment - methods
  • Risk factors
  • Stroke
  • Stroke (Disease)
  • Stroke - diagnosis
  • Stroke - epidemiology
  • Stroke - etiology
  • Surgery
  • Survival Rate - trends
  • Time Factors
ispartof: The American journal of cardiology, 2015, Vol.115 (10), p.1382-1388
description: 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.
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titlePredictors of Stroke Associated With Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease
creatorDomanski, Michael J., MD ; Farkouh, Michael E., MD ; Zak, Victor, PhD ; Feske, Steven, MD ; Easton, Donald, MD ; Weinberger, Jesse, MD ; Hamon, Martial, MD ; Escobedo, Jorge, MD, MSc ; Shrader, Peter, MA ; Siami, Flora S., MPH ; Fuster, Valentin, MD, PhD
creatorcontribDomanski, Michael J., MD ; Farkouh, Michael E., MD ; Zak, Victor, PhD ; Feske, Steven, MD ; Easton, Donald, MD ; Weinberger, Jesse, MD ; Hamon, Martial, MD ; Escobedo, Jorge, MD, MSc ; Shrader, Peter, MA ; Siami, Flora S., MPH ; Fuster, Valentin, MD, PhD
descriptionThis 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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0ISSN: 0002-9149
1EISSN: 1879-1913
2DOI: 10.1016/j.amjcard.2015.02.033
3PMID: 25824543
4CODEN: AJCDAG
languageeng
publisherUnited States: Elsevier Inc
subjectAbridged Index Medicus ; Adult ; Aged ; Aged, 80 and over ; Analysis ; Anticoagulants (Medicine) ; Blood pressure ; Cardiovascular ; Cardiovascular disease ; Care and treatment ; Confidence intervals ; Coronary artery bypass ; Coronary Artery Bypass - adverse effects ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - surgery ; Coronary heart disease ; Coronary vessels ; Diabetes ; Diabetes Mellitus ; Diabetics ; Family medical history ; Female ; Follow-Up Studies ; Global Health ; Heart attacks ; Heart surgery ; Hemorrhage ; Humans ; Incidence ; Low density lipoproteins ; Male ; Medical colleges ; Middle Aged ; Mortality ; Multivariate analysis ; Plants ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Risk Assessment - methods ; Risk factors ; Stroke ; Stroke (Disease) ; Stroke - diagnosis ; Stroke - epidemiology ; Stroke - etiology ; Surgery ; Survival Rate - trends ; Time Factors
ispartofThe American journal of cardiology, 2015, Vol.115 (10), p.1382-1388
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1Farkouh, Michael E., MD
2Zak, Victor, PhD
3Feske, Steven, MD
4Easton, Donald, MD
5Weinberger, Jesse, MD
6Hamon, Martial, MD
7Escobedo, Jorge, MD, MSc
8Shrader, Peter, MA
9Siami, Flora S., MPH
10Fuster, Valentin, MD, PhD
title
0Predictors of Stroke Associated With Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease
1The American journal of cardiology
addtitleAm J Cardiol
descriptionThis 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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4Analysis
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12Coronary Artery Bypass - adverse effects
13Coronary Artery Disease - complications
14Coronary Artery Disease - diagnosis
15Coronary Artery Disease - surgery
16Coronary heart disease
17Coronary vessels
18Diabetes
19Diabetes Mellitus
20Diabetics
21Family medical history
22Female
23Follow-Up Studies
24Global Health
25Heart attacks
26Heart surgery
27Hemorrhage
28Humans
29Incidence
30Low density lipoproteins
31Male
32Medical colleges
33Middle Aged
34Mortality
35Multivariate analysis
36Plants
37Postoperative Complications
38Prognosis
39Retrospective Studies
40Risk Assessment - methods
41Risk factors
42Stroke
43Stroke (Disease)
44Stroke - diagnosis
45Stroke - epidemiology
46Stroke - etiology
47Surgery
48Survival Rate - trends
49Time Factors
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titlePredictors of Stroke Associated With Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease
authorDomanski, Michael J., MD ; Farkouh, Michael E., MD ; Zak, Victor, PhD ; Feske, Steven, MD ; Easton, Donald, MD ; Weinberger, Jesse, MD ; Hamon, Martial, MD ; Escobedo, Jorge, MD, MSc ; Shrader, Peter, MA ; Siami, Flora S., MPH ; Fuster, Valentin, MD, PhD
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1Adult
2Aged
3Aged, 80 and over
4Analysis
5Anticoagulants (Medicine)
6Blood pressure
7Cardiovascular
8Cardiovascular disease
9Care and treatment
10Confidence intervals
11Coronary artery bypass
12Coronary Artery Bypass - adverse effects
13Coronary Artery Disease - complications
14Coronary Artery Disease - diagnosis
15Coronary Artery Disease - surgery
16Coronary heart disease
17Coronary vessels
18Diabetes
19Diabetes Mellitus
20Diabetics
21Family medical history
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25Heart attacks
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39Retrospective Studies
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44Stroke - diagnosis
45Stroke - epidemiology
46Stroke - etiology
47Surgery
48Survival Rate - trends
49Time Factors
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1Farkouh, Michael E., MD
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6Hamon, Martial, MD
7Escobedo, Jorge, MD, MSc
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7Escobedo, Jorge, MD, MSc
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abstractThis 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.
copUnited States
pubElsevier Inc
pmid25824543
doi10.1016/j.amjcard.2015.02.033
orcididhttps://orcid.org/0000-0003-1942-7402