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. 2024 Jan 17;11(1):27.
doi: 10.3390/jcdd11010027.

Outcomes after Perioperative Transient Ischemic Attack Following Cardiac Surgery

Urvish Jain  1 , Bhav Jain  2 , James Brown  3 , Ibrahim B Sultan  3 , Floyd Thoma  3 , Katherine M Anetakis  4 , Jeffrey R Balzer  4 , Kathirvel Subramaniam  5 , Sarah Yousef  3 , Yisi Wang  3 , Raul Nogueira  6 , Parthasarathy D Thirumala  4   6
Affiliations

Outcomes after Perioperative Transient Ischemic Attack Following Cardiac Surgery

Urvish Jain et al. J Cardiovasc Dev Dis. .

Abstract

Perioperative transient ischemic attacks (PTIAs) are associated with significantly increased rates of postoperative complications such as low cardiac output, atrial fibrillation, and significantly higher mortality in cardiac procedures. The current literature on PTIAs is sparse and understudied. Therefore, we aim to understand the effects of PTIA on hospital utilization, readmission, and morbidity. Using data on all the cardiac procedures at the University of Pittsburgh Medical Center from 2011 to 2019, fine and gray analysis was performed to identify whether PTIAs and covariables correlate with increased hospital utilization, stroke, all-cause readmission, Major Adverse Cardiac and Cerebrovascular Events (MACCE), MI, and all-cause mortality. Logistic regression for longer hospitalization showed that PTIA (HR: 2.199 [95% CI: 1.416-3.416] increased utilization rates. Fine and gray modeling indicated that PTIA (HR: 1.444 [95% CI: 1.096-1.902], p < 0.01) increased the rates of follow-up all-cause readmission. However, PTIA (HR: 1.643 [95% CI: 0.913-2.956] was not statistically significant for stroke readmission modeling. Multivariate modeling for MACCE events within 30 days of surgery (HR: 0.524 [95% CI: 0.171-1.605], p > 0.25) and anytime during the follow-up period (HR: 1.116 [95% CI: 0.825-1.509], p > 0.45) showed no significant correlation with PTIA. As a result of PTIA's significant burden on the healthcare system due to increased utilization, it is critical to better define and recognize PTIA for timely management to improve perioperative outcomes.

Keywords: cardiac surgery; perioperative transient ischemic attack; transient ischemic attack.

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Conflict of interest statement

I.B.S. reports research and grant support from Abbott, Artivion, AtriCure, Medtronic, Edwards Lifesciences, and Terumo Aortic. R.G.N. reports consulting fees for advisory roles with Anaconda, Biogen, CERENOVUS, Genentech, Philips, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz.ai, RapidPulse, and Perfuze. R.G.N. is one of the principal investigators of the “Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW)” trial. R.G.N. is the principal investigator of the “Combined Thrombectomy for Distal MediUm Vessel Occlusion StroKe (DUSK)” trial. R.G.N. is an investor in Viz.ai, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, Vastrax, and Viseon.

Figures

Figure 1
Figure 1
Study Design and Exclusion Criteria.
Figure 2
Figure 2
5 Year Kaplan-Meier Survival Analysis.
See this image and copyright information in PMC

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