Stable Cognition After Coronary Artery Bypass Grafting: Comparisons With Percutaneous Intervention and Normal Controls

doi:10.1016/j.athoracsur.2006.03.026

The Annals of Thoracic Surgery

Volume 82, Issue 2, August 2006, Pages 597-607

https://doi.org/10.1016/j.athoracsur.2006.03.026 Get rights and content

Background

Cognitive decline has been associated with coronary artery bypass grafting (CABG), but the extent to which these findings are related to the natural history of cognitive deficits in elderly patients with cardiac disease or have been influenced by the research methods used to determine abnormalities warrants further study.

Methods

After excluding individuals with conditions known to cause brain dysfunction, individuals referred for percutaneous coronary intervention (n = 42) or CABG (n = 35) were compared with an age-matched and education-matched control group without clinical evidence of coronary artery disease (n = 44). These subjects underwent a battery of 14 neurocognitive tests at baseline (preoperatively) and at 3 weeks and 4 months postoperatively.

Results

The majority of test scores for all three cohorts were within nonimpaired ranges at baseline and 3 weeks later. Change in impairment status from baseline to 3-week assessment was not associated statistically with type of treatment as referenced to clinical norms, and was associated with type of treatment on only one measure as referenced to control group performances. A further overall improvement in impairment status from 3 weeks’ to 4 months’ follow-up was seen in both CABG and percutaneous coronary intervention patients. Mean test scores were significantly worse in CABG patients versus percutaneous coronary intervention patients in 4 of 13 measures at 3 weeks’ follow-up, but significant de novo impairment at 3 weeks’ follow-up in the CABG group compared with the percutaneous coronary intervention and control groups was present in only one test. As assessed by reliable change methodology, impairment was statistically associated with type of treatment for only 1 of 13 measures.

Conclusions

As compared with changes seen in repeat testing of healthy control subjects and individuals who underwent percutaneous coronary intervention, clinically meaningful cognitive deterioration was not observed after CABG.

Section snippets

Enrollment

Institutional review board approval was obtained in February 2002, and fully informed written consent was obtained from individuals selected for participation in this study. Prospective participants in the two cardiac groups (CABG or PCI) were screened by project personnel subsequent to physician referral based on standard clinical indications for either CABG or PCI. Exclusion criteria for cardiac patients included those reflecting excessive risk of neurologic events, or potential inability to

Intergroup Conformity

The three cohorts were well matched for age, and each group was relatively well educated, with well over half of each group having a college degree or advanced degree (Table 2). There were more men than women in the CABG and PCI groups, with the control group being equally divided, reflective of the distribution of sex in these populations. Patterns of comorbidities in the CABG and PCI subjects were consistent with the degree of atherosclerotic disease in these groups and the relatively limited

Comment

The present study demonstrates that the majority of neurocognitive functions measured as early as 3 weeks postoperatively are essentially unchanged compared with baseline in individuals undergoing CABG surgery. These findings are consistent with the recent review of Selnes and McKhann [7], who concluded that in current studies neurocognitive complications of CABG were mild.

Within the present study, results varied considerably depending on which of four analytic methods were used to determine

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Citation Excerpt :
Overall, the presence of microlesions was associated with a decline in cognitive tests. In the pertinent literature, a small variety of studies used patients who underwent cardiac catheterization as a control group for CABG.4-7,14,15 Interestingly, nearly all of these studies failed to attest postoperative cognitive decline in the CABG group in comparison with a PCI group.
Postinterventional cognitive dysfunction (PICD) is a known complication of coronary artery bypass grafting (CABG). However, it is largely unknown whether PICD occurs after coronary catheterization.
Neuropsychologic data were obtained from 37 patients who received coronary catheterization and 47 patients who underwent elective CABG at baseline and 3 months after the interventions. The outcomes were contrasted to 33 healthy volunteers, using analysis of covariance with baseline scores as covariates. Cerebral magnetic resonance imaging with diffusion-weighted imaging (DWI) sequences was performed in 30 catheter and 39 CABG patients 2 to 4 days after the procedures.
The rate of acute ischemic lesions amounted to 3.3% in the catheter group and to 17.9% in the CABG group. Postinterventional cognitive dysfunction was detected in 2 (of 10) tests in the catheter group as compared with the healthy controls (verbal memory: total recall, t = −2.61 (P = .005) and nonverbal memory, t = −2.60 [P = .005]). The CABG group showed PICD in 7 of 10 tests as compared with the healthy controls (statistics ranging from t = −1.95 [P = .027] to t = −5.14 [P < .001]). Scores of depression/anxiety and health-related quality of life were not associated with PICD (P > .05).
As compared with CABG, PICD and cerebral lesions appear to be substantially milder after coronary catheter intervention, but not negligible.

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Original articleCardiovascularStable Cognition After Coronary Artery Bypass Grafting: Comparisons With Percutaneous Intervention and Normal Controls

Background

Methods

Results

Conclusions

Section snippets

Enrollment

Intergroup Conformity

Comment

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

J Cardiothorac Vasc Anesth

Br J Anaesth

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery

N Engl J Med

Adverse cerebral outcomes after coronary bypass surgery

N Engl J Med

Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting

Ann Thorac Surg

Brain damage during cardiopulmonary bypass

Ann Thorac Surg

Reduced mortality and strokes with off-pump coronary artery bypass grafting in octogenarians

Circulation

Neurocognitive complications after coronary artery bypass surgery

Ann Neurol

What is cognitive reserve? Theory and research application of the reserve concept

J Intern Neuropsychol Soc

MMSEMini-Mental State Examination user’s guide

Original article
Cardiovascular
Stable Cognition After Coronary Artery Bypass Grafting: Comparisons With Percutaneous Intervention and Normal Controls