AMI patients undergoing CABG within 48 hours are at an increased risk for neurological injuries, with patients with generalized atherosclerosis and those who underwent CPR pre-operatively representing a particularly vulnerable subgroup.
The overall rate of peri-operative neurological events in AMI patients undergoing CABG within 48 hours was 4.7%.
Pre-operative cardiopulmonary resuscitation (CPR) was significantly more common in patients who developed neurological events.
Neurological event patients had significantly higher pre-operative surgical risk scores than patients without neurological events.
Intraoperative cardiopulmonary bypass time was significantly longer in patients who developed neurological events.
Neurological event patients had significantly longer post-operative ICU stays.
Thirty-day mortality was significantly higher in patients who suffered neurological events.
Long-term survival at ten years was substantially worse in patients who experienced neurological events.
Peripheral artery disease and pre-operative CPR were identified as independent predictors of 30-day mortality specifically in neurological event patients.
This research suggests that among patients who have a heart attack and then undergo emergency coronary bypass surgery within 48 hours, approximately 1 in 21 (4.7%) will experience a serious neurological complication such as a stroke or brain damage from lack of oxygen. The study analyzed over 1,600 patients treated at a single center over more than 20 years, making it one of the more substantial datasets examining this specific high-risk situation. The most common neurological complication was a thrombotic or embolic stroke (4.0%), while oxygen-related brain injury was less common (0.7%). This research suggests that certain patients are at particularly high risk for these neurological complications. Patients who needed CPR before surgery, those with signs of widespread arterial disease (such as peripheral artery disease), heavy smokers, and those with severely weakened heart function were more likely to suffer neurological events. When a neurological event did occur, the consequences were severe: 30-day death rates were nearly double compared to patients without neurological complications (20.8% vs. 10.7%), and ten-year survival was dramatically reduced (39% vs. 69%). Longer time on the heart-lung bypass machine during surgery was also associated with neurological events. This research suggests that identifying high-risk patients before emergency bypass surgery—particularly those with a history of CPR or widespread vascular disease—could be important for developing strategies to reduce brain injury in this vulnerable population. The authors note that further studies are needed to determine whether specific individualized precautions during surgery could reduce stroke rates in these highest-risk patients.
Heumüller F, Huenges K, Trigui N, Tulun A, Markscheffel B, Panholzer B, et al.. (2026). Neurological injury in patients with acute myocardial infarction undergoing operative myocardial revascularization within 48 h.. Journal of cardiothoracic surgery. https://doi.org/10.1186/s13019-026-04181-y