Our Summary
This research paper looks at the risk and impact of strokes that occur during or shortly after heart procedures. The study focused on two types of heart procedures: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The researchers looked at data from nearly 15,000 patients who had these procedures between 2011 and 2013.
The study found that almost 1% of patients who had PCI and over 2% of patients who had CABG experienced a stroke within 30 days of their procedure. Many of these patients had at least a mild disability when they left the hospital. Certain factors increased the risk of having a stroke during or after these procedures. For PCI these factors included having acute coronary syndrome (a term for situations where blood supplied to the heart muscle is suddenly blocked), carotid artery disease (blockage or narrowing in the neck arteries), being older, having heart failure, and end-stage renal disease (final stage of chronic kidney disease). For CABG, the risk factors were similar with the addition of atrial fibrillation (irregular heartbeat), chronic obstructive pulmonary disease (lung disease), cancer, and frailty.
Importantly, the study found that patients who had a stroke during or after these procedures had a higher risk of dying in the long term. The researchers conclude that the risk of stroke during or after these heart procedures is not insignificant and could result in long-term health concerns.
FAQs
- What are the identified risk factors for having a stroke during or after PCI and CABG procedures?
- What percentage of patients experienced a stroke within 30 days of their PCI or CABG procedure?
- What are the potential long-term health implications for patients who have a stroke during or after these heart procedures?
Doctor’s Tip
A helpful tip a doctor might tell a patient about CABG is to carefully manage and control any pre-existing conditions that increase the risk of stroke, such as atrial fibrillation, chronic obstructive pulmonary disease, and carotid artery disease. It is important for patients to work closely with their healthcare team to optimize their overall health before undergoing CABG to reduce the risk of complications, including stroke. Additionally, patients should follow their doctor’s recommendations for post-operative care and rehabilitation to improve their chances of a successful recovery.
Suitable For
Patients who are typically recommended for CABG (coronary artery bypass grafting) include those who have severe coronary artery disease, which is when the arteries that supply blood to the heart become narrowed or blocked by plaque buildup. This can lead to chest pain (angina) or a heart attack.
Specifically, patients who may be recommended for CABG are those who have:
- Severe blockages in multiple coronary arteries
- Left main coronary artery disease
- Severe blockages that cannot be treated effectively with medications or other less invasive procedures such as angioplasty or stenting
- Continued symptoms of angina or heart failure despite optimal medical therapy
- Previous heart procedures that were not successful or have resulted in complications
- Diabetes, especially if it is poorly controlled
- Patients with a history of heart attacks or heart failure
It is important for patients to discuss their individual case with their healthcare provider to determine if CABG is the best treatment option for them.
Timeline
Before CABG:
- Patient is diagnosed with coronary artery disease and is recommended for CABG surgery
- Patient undergoes pre-operative tests and evaluations to assess their overall health and determine the best course of treatment
- Patient may need to make lifestyle changes and take medications to prepare for surgery
- Patient is scheduled for the CABG procedure and receives pre-operative instructions
After CABG:
- Patient undergoes the CABG surgery, where blocked arteries are bypassed using blood vessels from other parts of the body
- Patient is monitored closely in the intensive care unit (ICU) immediately after surgery
- Patient may experience pain, discomfort, and fatigue in the days following surgery
- Patient begins cardiac rehabilitation to help improve heart health and recovery
- Patient is discharged from the hospital and continues with follow-up appointments with their healthcare team
- Patient may need to make further lifestyle changes, take medications, and attend cardiac rehabilitation sessions to improve their overall heart health and reduce the risk of future heart problems.
What to Ask Your Doctor
Some questions a patient should ask their doctor about CABG include:
- What is my personal risk of experiencing a stroke during or after the CABG procedure?
- What specific factors in my medical history may increase my risk of having a stroke during or after CABG?
- How will you monitor and manage my risk of stroke during and after the procedure?
- What steps will be taken to prevent a stroke during the CABG surgery?
- What are the symptoms of a stroke that I should watch out for after the procedure?
- What are the potential long-term effects of experiencing a stroke during or after CABG?
- What can I do to lower my risk of having a stroke during or after the CABG procedure?
- Are there any alternative treatments or procedures that may lower my risk of stroke compared to CABG?
- How will my recovery plan be adjusted if I do experience a stroke during or after the procedure?
- Are there any lifestyle changes or medications I should consider to reduce my risk of stroke in the future after undergoing CABG?
Reference
Authors: Yamamoto K, Natsuaki M, Morimoto T, Shiomi H, Matsumura-Nakano Y, Nakatsuma K, Watanabe H, Yamamoto E, Kato E, Fuki M, Yamaji K, Nishikawa R, Nagao K, Takeji Y, Watanabe H, Tazaki J, Watanabe S, Saito N, Yamazaki K, Soga Y, Komiya T, Ando K, Minatoya K, Furukawa Y, Nakagawa Y, Kadota K, Kimura T; CREDO-Kyoto PCI/CABG Registry Cohort-3 investigators. Journal: Am J Cardiol. 2021 Mar 1;142:35-43. doi: 10.1016/j.amjcard.2020.11.031. Epub 2020 Dec 3. PMID: 33279479