Preoperative Hematocrit Concentration and the Risk of Stroke in Patients Undergoing Isolated Coronary-Artery Bypass Grafting
Khaled M. Musallam,
Faek R. Jamali,
Frits R. Rosendaal,
Toby Richards,
Donat R. Spahn,
Kaivan Khavandi,
Iskandar Barakat,
Benjamin Demoss,
Luca A. Lotta,
Flora Peyvandi,
Pier M. Sfeir
Affiliations
Khaled M. Musallam
Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut 1107 2020, Lebanon
Faek R. Jamali
Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut 1107 2020, Lebanon
Frits R. Rosendaal
Departments of Clinical Epidemiology and Thrombosis & Hemostasis, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
Toby Richards
Division of Surgery and Interventional Science, University College London Hospital, London WC1E 6AU, UK
Donat R. Spahn
Institute of Anesthesiology, University Hospital and University of Zurich, 8006 Zurich, Switzerland
Kaivan Khavandi
King’s College London British Heart Foundation Centre, The Rayne Institute, St. Thomas’ Hospital, King’s Health Partners AHSC, London SE1 7EH, UK
Iskandar Barakat
Department of Medicine, Staten Island University Hospital, New York, NY 10305, USA
Benjamin Demoss
Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
Luca A. Lotta
Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, 20122 Milan, Italy
Flora Peyvandi
Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Department of Medicine and Medical Specialties, IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, 20122 Milan, Italy
Pier M. Sfeir
Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut 1107 2020, Lebanon
Background. Identification and management of risk factors for stroke following isolated coronary artery bypass grafting (CABG) could potentially lower the risk of such serious morbidity. Methods. We retrieved data for 30-day stroke incidence and perioperative variables for patients undergoing isolated CABG and used multivariate logistic regression to assess the adjusted effect of preoperative hematocrit concentration on stroke incidence. Results. In 2,313 patients (mean age 65.9 years, 73.6% men), 43 (1.9%, 95% CI: 1.4–2.5) developed stroke within 30 days following CABG (74.4% within 6 days). After adjustment for a priori defined potential confounders, each 1% drop in preoperative hematocrit concentration was associated with 1.07 (95% CI: 1.01–1.13) increased odds for stroke (men, OR: 1.08, 95% CI: 1.01–1.16; women, OR: 1.02, 95% CI: 0.91–1.16). The predicted probability of stroke for descending preoperative hematocrit concentration exceeded 2% for values <37% (<37% for men (adjusted OR: 2.39, 95% CI: 1.08–5.26) and <38% for women (adjusted OR: 2.52, 95% CI: 0.53–11.98), with a steeper probability increase noted in men). The association between lower preoperative hematocrit concentration and stroke was evident irrespective of intraoperative transfusion use. Conclusion. Screening and management of patients with low preoperative hematocrit concentration may alter postoperative stroke risk in patients undergoing isolated CABG.
