Neurological events in patients undergoing CABG within 48hours after diagnosed with acute myocardial infarction

Frederik Heumüller (Kiel)1, N. Rainer-Schmidt (Kiel)1, L. Hüttmann (Kiel)1, N. Blum (Kiel)1, B. Panholzer (Kiel)1, K. Huenges (Kiel)1, G. Warnecke (Kiel)1, J. Cremer (Kiel)2, C. Grothusen (Dortmund)3

1Universitätsklinikum Schleswig-Holstein Kiel, Deutschland; 2Universitätsklinikum Schleswig-Holstein Klinik für Herz- und Gefäßchirurgie Kiel, Deutschland; 3Kath. St. Paulus Gesellschaft Klinik für Innere Medizin I Dortmund, Deutschland


Background: Acute myocardial infarction (AMI) is associated with an increased risk of neurological injuries. AMI patients, who undergo CABG may be at an even greater risk for peri-operative neurological events. We analysed the rate of neurological events in AMI patients that underwent CABG within 48 hours.


Methods: The data of 1628 AMI patients that underwent CABG within 48hours was retrospectively analysed. Median time from AMI diagnosis to CABG was 7.6 hrs (4.4-16.2).


Results: Overall, 77 patients (4.7%) suffered from a neurological event peri-operatively. This included 66 (85%) strokes, as diagnosed by CT  and 11 hypoxic brain damages (12%). One patient suffered from a combination of both entities. Significantly more patients with a neurological event presented with a history of smoking and COPD as well as a severely reduced left ventricular function. 29% of patients with a neurological event had undergone cardio-pulmonary resuscitation (CPR) prior to surgery. Intra-operative parameters did not differ between the groups. Post-operative lactate levels were higher in patients with a neurological event. These patients were longer ventilated and stayed longer in die ICU. Thirty day mortality was higher in these particular patients ( 10.2% vs 20.7%;p<0.01). Long-term survival over 20 years was significantly reduced in patients with neurological events (p<0.001). 


Conclusion: The overall rate of neurological events was increased in AMI patients undergoing CABG. Almost one third of these patients had to be resuscitated prior to surgery. These patients represent a highly vulnerable subgroup and treatment regimens should be very carefully discussed.  

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