Carotid Plaque-Reporting and Data System for Predicting In-Hospital Ischemic Stroke After Coronary Artery Bypass Graft-Containing Cardiac Surgery: Complementary Value Beyond Stenosis Severity.
Although carotid atherosclerosis is a recognized risk factor, the relationship between plaque characteristics and clinical outcomes after cardiac surgery remains unclear.
We retrospectively studied 1087 patients undergoing coronary artery bypass graft-containing cardiac surgery between January 2023 and January 2024. Preoperative carotid ultrasound was used to assign Carotid Plaque-Reporting and Data System (Plaque-RADS) grades 1 to 4. The primary outcome was in-hospital ischemic stroke. Given the low number of events, associations were evaluated using Firth penalized logistic regression with limited covariate adjustment.
In-hospital ischemic stroke occurred in 14 patients (1.3%). Stroke incidence increased across Plaque-RADS grades from 0% in grade 1 to 0.6%, 2.0%, and 6.3% in grades 2, 3, and 4, respectively (P=0.011). Higher Plaque-RADS grade was associated with greater odds of in-hospital ischemic stroke after adjustment for age, sex, surgical procedure, operative time, and aortic atherosclerotic burden (odds ratio per 1-grade increase, 4.31 [95% CI, 1.72-11.43]; P=0.002). The association was directionally similar among patients with carotid stenosis <50%. In exploratory discrimination analyses, the model including both stenosis and Plaque-RADS had the highest numerical area under the receiver operating characteristic curve, although the incremental gain over either individual parameter was modest.
Higher ultrasound-based Plaque-RADS grade was associated with in-hospital ischemic stroke after coronary artery bypass graft-containing cardiac surgery. Plaque-RADS may provide complementary risk information. These findings should be considered hypothesis generating and require validation in larger prospective cohorts.
We retrospectively studied 1087 patients undergoing coronary artery bypass graft-containing cardiac surgery between January 2023 and January 2024. Preoperative carotid ultrasound was used to assign Carotid Plaque-Reporting and Data System (Plaque-RADS) grades 1 to 4. The primary outcome was in-hospital ischemic stroke. Given the low number of events, associations were evaluated using Firth penalized logistic regression with limited covariate adjustment.
In-hospital ischemic stroke occurred in 14 patients (1.3%). Stroke incidence increased across Plaque-RADS grades from 0% in grade 1 to 0.6%, 2.0%, and 6.3% in grades 2, 3, and 4, respectively (P=0.011). Higher Plaque-RADS grade was associated with greater odds of in-hospital ischemic stroke after adjustment for age, sex, surgical procedure, operative time, and aortic atherosclerotic burden (odds ratio per 1-grade increase, 4.31 [95% CI, 1.72-11.43]; P=0.002). The association was directionally similar among patients with carotid stenosis <50%. In exploratory discrimination analyses, the model including both stenosis and Plaque-RADS had the highest numerical area under the receiver operating characteristic curve, although the incremental gain over either individual parameter was modest.
Higher ultrasound-based Plaque-RADS grade was associated with in-hospital ischemic stroke after coronary artery bypass graft-containing cardiac surgery. Plaque-RADS may provide complementary risk information. These findings should be considered hypothesis generating and require validation in larger prospective cohorts.