TY - JOUR
T1 - Do Management Strategies for Coronary Artery Disease Influence 6-Year Cognitive Outcomes?
AU - Selnes, Ola A.
AU - Grega, Maura A.
AU - Bailey, Maryanne M.
AU - Pham, Luu D.
AU - Zeger, Scott L.
AU - Baumgartner, William A.
AU - McKhann, Guy M.
N1 - Funding Information:
This study was supported by grant 35610 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; by the Dana Foundation, New York, NY; and by the Johns Hopkins Medical Institution GCRC grant RR 00052. The authors thank the participating physicians and surgeons who contributed to patient recruitment from our institution, as well as referring off-pump surgical sites. We acknowledge the efforts of Louis M. Borowicz, Jr., who assisted in the coordination of the study and neuropsychological testing, and thank Pamela Talalay, PhD, Rebecca Gottesman, MD, and Marilyn Albert, PhD, for their assistance in manuscript preparation. Special thanks are extended to our study participants who volunteered their time and energy to make this study possible.
PY - 2009/8
Y1 - 2009/8
N2 - Background: Previous uncontrolled studies have suggested that there is late cognitive decline after coronary artery bypass grafting that may be attributable to use of the cardiopulmonary bypass pump. Methods: In this prospective, nonrandomized, longitudinal study, we compared cognitive outcomes after on-pump coronary artery bypass surgery (n = 152) with off-pump bypass surgery patients (n = 75); nonsurgical cardiac comparison subjects (n = 99); and 69 heart-healthy comparison (HHC) subjects. The primary outcome measure was change from baseline to 72 months in the following cognitive domains: verbal memory, visual memory, visuoconstruction, language, motor speed, psychomotor speed, attention, executive function, and a composite global score. Results: There were no consistent differences in 72-month cognitive outcomes among the three groups with coronary artery disease (CAD). The CAD groups had lower baseline performance, and a greater degree of decline compared with HHC. The degree of change was small, with none of the groups having more than 0.5 SD decline. None of the groups was substantially worse at 72 months compared with baseline. Conclusions: Compared with subjects with no vascular disease risk factors, the CAD patients had lower baseline cognitive performance and greater degrees of decline over 72 months, suggesting that in these patients, vascular disease may have an impact on cognitive performance. We found no significant differences in the long-term cognitive outcomes among patients with various CAD therapies, indicating that management strategy for CAD is not an important determinant of long-term cognitive outcomes.
AB - Background: Previous uncontrolled studies have suggested that there is late cognitive decline after coronary artery bypass grafting that may be attributable to use of the cardiopulmonary bypass pump. Methods: In this prospective, nonrandomized, longitudinal study, we compared cognitive outcomes after on-pump coronary artery bypass surgery (n = 152) with off-pump bypass surgery patients (n = 75); nonsurgical cardiac comparison subjects (n = 99); and 69 heart-healthy comparison (HHC) subjects. The primary outcome measure was change from baseline to 72 months in the following cognitive domains: verbal memory, visual memory, visuoconstruction, language, motor speed, psychomotor speed, attention, executive function, and a composite global score. Results: There were no consistent differences in 72-month cognitive outcomes among the three groups with coronary artery disease (CAD). The CAD groups had lower baseline performance, and a greater degree of decline compared with HHC. The degree of change was small, with none of the groups having more than 0.5 SD decline. None of the groups was substantially worse at 72 months compared with baseline. Conclusions: Compared with subjects with no vascular disease risk factors, the CAD patients had lower baseline cognitive performance and greater degrees of decline over 72 months, suggesting that in these patients, vascular disease may have an impact on cognitive performance. We found no significant differences in the long-term cognitive outcomes among patients with various CAD therapies, indicating that management strategy for CAD is not an important determinant of long-term cognitive outcomes.
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U2 - 10.1016/j.athoracsur.2009.04.061
DO - 10.1016/j.athoracsur.2009.04.061
M3 - Article
C2 - 19632391
AN - SCOPUS:67650726487
SN - 0003-4975
VL - 88
SP - 445-454.e3
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -