Factores de riesgo cardiovascular y deterioro cognitivo tras cirugía de revascularización coronaria sin circulación extracorpórea

ResumenIntroducción y objetivosEl deterioro cognitivo postoperatorio es una importante complicación tras la cirugía cardíaca. En este estudio prospectivo se determina su presencia e identifica los factores de riesgo cardiovascular implicados.MétodosTreinta y seis pacientes programados para cirugía coronaria electiva sin circulación extracorpórea fueron evaluados usando una batería neurocognitiva pre y posquirúrgicamente (uno, 6 y 12 meses), estableciéndose el deterioro cognitivo como una disminución significativa del rendimiento respecto a niveles preoperatorios. Las variables implicadas se obtuvieron mediante un análisis de regresión múltiple.ResultadosSe mostró deterioro cognitivo postoperatorio multidominio (funciones ejecutivas-atención, p < 0,01; memoria inmediata y diferida, p < 0,001; y fluidez verbal, p < 0,05), máximo a los 6 meses de seguimiento. La historia de tabaquismo (p < 0,001), diabetes mellitus (p < 0,01), arteriopatía periférica (p < 0,01) y obesidad (p = 0,03) fueron identificadas como las variables predictoras cardiovasculares.ConclusionesLa identificación del deterioro cognitivo postoperatorio y sus variables asociadas puede ser útil para adoptar medidas preventivas y aconsejar a nuestros pacientes preoperatoriamente.

Background and objectivesPostoperative cognitive impairment is considered to be an important complication after cardiac surgery. In this prospective study has been determined its presence and has been identified risk factors involved in it.Methods36 patients undergoing elective off-pump coronary surgery were evaluated using a neurocognitive battery before and after surgery (at 1, 6 and 12 months). Postoperative cognitive impairment was defined by a significant decrease in neuropsychological test scores from before to after surgery. Multiple regression analyses were used to identify independent predictors.ResultsA multi-domain postoperative cognitive impairment was showed (attention-executive functions (p < 0.01), immediate and delayed memory (p < 0.001) and verbal fluency (p < 0.05), maximum at 6-months follow-up. The history of smoking (p < 0.001), diabetes mellitus (p < 0.01), peripheral arteriopathy (p < 0.01) and obesity (p = 0.03) were identified as cardiovascular predictors of postoperative cognitive impairment.ConclusionsThe identification of postoperative cognitive impairment and its associated risk factors may be useful to adopt preventive and counseling strategies preoperatively.