• Hyun-Uk Kang, Ji-Hoon Sim, Jae-Sik Nam, Duk-Woo Park, Jung-Min Ahn, Ho Jin Kim, Ji-Hyeon Kim, Wan-Woo Seo, Kyung-Woon Joung, Ji-Hyun Chin, Dae-Kee Choi, Cheol Hyun Chung, and In-Cheol Choi.
• Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
• J. Cardiothorac. Vasc. Anesth. 2024 Sep 26.

ObjectiveTo determine the association between preoperative covert brain infarction following coronary angiography (CAG) and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass grafting (CABG).DesignA cohort study was conducted between January 2006 and December 2019, with the follow-up period concluding at either 5 years after surgery, the date of death, or April 27, 2023.SettingA single tertiary center in Korea.ParticipantsPatients who underwent preoperative CAG and subsequent brain magnetic resonance imaging (MRI) before elective CABG.InterventionsNone.Measurements And Main ResultsThe primary outcome was the incidence of MACCEs within 30 days of CABG. MACCEs included operative death (all-cause death within 30 days of surgery or before discharge), myocardial infarction, mechanical circulatory support, circulatory arrest, and stroke. Secondary outcomes included each component of MACCEs and all-cause mortality at 5 years after surgery. Of the 2,476 study patients (median [interquartile range] age: 65 [58-71] years; 24.7% were female), 212 (8.6%) had covert cerebral infarction on brain MRI after CAG but before CABG, and 353 (14.3%) patients experienced MACCEs after CABG. After performing 1:4 propensity-score matching, 1,057 patients were included in the final outcome analysis (212 with covert brain infarction and 845 without). The incidence of MACCEs within 30 days was not significantly different between patients with covert brain infarction and those without (15.1% [32/212] v 15.6% [132/845]; risk difference: -0.5, 95% confidence interval: -5.6 to 4.4; risk ratio: 0.97, 95% confidence interval: 0.66 to 1.32, p = 0.85). There were also no significant differences in each component of MACCEs within 30 days. There was no significant difference between the two groups regarding all-cause mortality at 5 years (18.7% v 17.0%, respectively, p for stratified log-rank test = 0.33).ConclusionsAmong patients undergoing elective CABG, there was no significant association between covert brain infarction following CAG and the occurrence of MACCEs within 30 days or long-term mortality after CABG.Copyright © 2024 Elsevier Inc. All rights reserved.

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