Dr. Rudolph was supported by a Hartford/American Federation for Aging Research Academic Fellowship Program in Geriatric Medicine grant, a Harvard/Hartford Junior Faculty Development grant, and the Hebrew Rehabilitation Center for Aged Men's Fellowship.
Atherosclerosis Is Associated with Delirium After Coronary Artery Bypass Graft Surgery
Article first published online: 24 FEB 2005
Journal of the American Geriatrics Society
Volume 53, Issue 3, pages 462–466, March 2005
How to Cite
Rudolph, J. L., Babikian, V. L., Birjiniuk, V., Crittenden, M. D., Treanor, P. R., Pochay, V. E., Khuri, S. F. and Marcantonio, E. R. (2005), Atherosclerosis Is Associated with Delirium After Coronary Artery Bypass Graft Surgery. Journal of the American Geriatrics Society, 53: 462–466. doi: 10.1111/j.1532-5415.2005.53165.x
- Issue published online: 24 FEB 2005
- Article first published online: 24 FEB 2005
- CABG surgery;
- carotid stenosis;
- ascending aorta
Objectives: To investigate whether atherosclerosis of the ascending aorta, internal carotid arteries, and coronary arteries is predictive of postoperative delirium in subjects undergoing coronary artery bypass graft (CABG) surgery.
Design: Prospective cohort study.
Setting: Boston Veterans Affairs Healthcare System.
Participants: Thirty-six male veterans undergoing primary CABG surgery.
Measurements: Subjects underwent Duplex ultrasound to assess stenosis in the internal carotid arteries. Information on the ascending aortic plaque, as assessed by transesophageal echocardiogram, and the number of coronary vessels bypassed was collected. To create an atherosclerosis score, the number of atherosclerotic areas was added. A validated delirium battery was administered to the subjects preoperatively and on postoperative Days 2 and 5.
Results: Fifteen subjects (41.7%) developed delirium postoperatively. In bivariate analysis, carotid stenosis of 50% or more (relative risk (RR)=3.5, 95% confidence interval (CI)=1.5–8.1) and moderate-severe ascending aortic plaque (RR=2.9, 95% CI=1.0–8.5) were significantly associated with the development of delirium. There was a trend toward a significant association for three or more vessels bypassed (RR=9.6, 95% CI=0.6–145.3). After controlling for age, baseline cognition, and medical comorbidity, the atherosclerosis score was significantly associated with postoperative delirium (adjusted RR=2.7, 95% CI=1.1–6.8).
Conclusion: In this preliminary report, atherosclerosis in the carotid arteries, aorta, and coronary circulation is associated with the development of delirium after CABG surgery. Further investigation into atherosclerosis as a risk factor for delirium is warranted.