Identification of preoperative risk factors associated with stroke in Blacks following first-time coronary artery bypass graft surgery: A retrospective study

Coronary artery bypass graft (CABG) is an important therapeutic option for patients with coronary artery disease. The number of Blacks undergoing CABG has almost doubled in the last decade. As the Black population continues to grow so will the number undergoing CABG increase. Despite the refinement in surgical and anesthetic techniques, the incidence of stroke following CABG continues to rise. Differential incidence of stroke in Blacks cannot be determined because previous studies either did not analyze data by race or only small populations of Blacks were included in the studies. No studies were found that focused solely on the preoperative risk factors associated with stroke in Blacks following CABG. Therefore, the purpose of this study was to identify preoperative risk factors associated with stroke in Blacks following CABG. Giger and Davidhizar's Transcultural Nursing Assessment and Intervention model was used to guide the study. A medical records review of all self-identified Blacks who underwent CABG between January 1993 and May 2000 at a 586 bed for-profit local hospital was conducted. Univariate and multivariate analyses were done using chi-square, t-test, and forward logistic regression techniques. A total of 311 patients underwent CABG. A total of 32 (10.3%) had strokes. Univariate analysis indicated increased age; job class; marital status; employment status; atrial fibrillation; renal failure; family history of hypertension; cardiac ejection fraction less than 50%; and current use of uricosuric, epogen, or anticoagulants were significant risk factors for stroke. Multivariate logistic regression revealed that variables associated with stroke were left anterior descending coronary artery stenosis >50%; atrial fibrillation; osteoarthritis; CPB greater than 100 min; blue collar worker; and current use of epogen, steroids and uricosuric agents. Also, currently not taking aspirin increased the likelihood of stroke. The majority of strokes were ischemic, occurred in the middle cerebral artery, and were small in size. Fifty percent of the strokes occurred by postoperative Day 1. Over 90% of the stroke patients required short- or long-term care at discharge. Demographic, social organization, and biological variables were identified as risk factors associated with stroke in Blacks following CABG. The importance of the mobilization of social support such as family and religious affiliations was supported in this study. Nurses could use the framework in this study to identify those at risk and mobilize an individualized plan of care to include aggressive strategies such as preoperative administration of neuroprotective agents, aggressive presurgical assessment, and management of existing diseases and advocate for medical or minimally invasive cardiac bypass surgery procedure. These strategies may help reduce the risk of stroke and eventually cost and resource utilization.