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. 2008 Mar;85(3):872-9.
doi: 10.1016/j.athoracsur.2007.10.083.

Cognitive outcomes three years after coronary artery bypass surgery: relation to diffusion-weighted magnetic resonance imaging

Stephan C Knipp  1 , Nadine Matatko, Hans Wilhelm, Marc Schlamann, Matthias Thielmann, Christian Lösch, Hans C Diener, Heinz Jakob
Affiliations

Cognitive outcomes three years after coronary artery bypass surgery: relation to diffusion-weighted magnetic resonance imaging

Stephan C Knipp et al. Ann Thorac Surg. 2008 Mar.

Abstract

Background: Cognitive decline is well recognized early after coronary artery bypass graft surgery (CABG), but controversy exists regarding the degree and duration of these changes. We investigated the course of cognitive performance during 3 years after surgery and determined whether ischemic brain injury detected by diffusion-weighted magnetic resonance imaging was related to cognitive decline.

Methods: Thirty-nine patients undergoing on-pump CABG completed preoperative neuropsychologic examination and were followed up prospectively at discharge, 3 months, and 3 years after surgery. Cognitive performance was assessed with a battery of 11 standardized psychometric tests assessing 7 cognitive domains. Cognitive outcome was analyzed by determining (1) mean changes in within-patient scores over time (identifying cognitive functions with decline), and (2) the incidence of cognitive deficit for each individual (identifying patients with decline). Objective evidence of acute cerebral ischemia was obtained by diffusion-weighted magnetic resonance imaging. Prospectively collected data were used to identify predictors of cognitive deficits.

Results: From baseline to discharge, cognitive test scores significantly declined in 7 measures. Most tests improved by 3 months. Between 3 months and 3 years, late decline was observed in 2 measures with persistent deterioration in 1 measure (verbal memory) relative to baseline. Postoperative cognitive deficits (drop of > or = 1 SD in scores on > or = 3 tests) were observed in 56% of patients at discharge, 23% at 3 months and 31% at 3 years. On postoperative diffusion-weighted magnetic resonance imaging, there were new ischemic cerebral lesions in 51% of patients. The presence of cognitive deficit at discharge was a significant univariate predictor of late cognitive decline (p = 0.025). A relation between the presence of new diffusion-weighted magnetic resonance imaging detected lesions and cognitive decline, however, was not found.

Conclusions: Longitudinal cognitive performance of patients with CABG showed a two-stage course with early improvement followed by later decline. Long-term cognitive deficit was predicted by early cognitive decline, but not by ischemic brain lesions on magnetic resonance imaging.

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Comment in

  • Invited commentary.
    Grocott HP. Grocott HP. Ann Thorac Surg. 2008 Mar;85(3):879. doi: 10.1016/j.athoracsur.2007.11.071. Ann Thorac Surg. 2008. PMID: 18291161 No abstract available.
  • Postoperative ischemia and cognitive impairment in cardiac surgery patients.
    Barber PA, Tippett LJ, Merry A, Hach S, Frampton C, Milsom P. Barber PA, et al. Ann Thorac Surg. 2009 Feb;87(2):672-3; author reply 673-4. doi: 10.1016/j.athoracsur.2008.05.021. Ann Thorac Surg. 2009. PMID: 19161820 No abstract available.