Abstract:

AIM: The study was designed to investigate the correlation between preoperative cigarette smoking and postoperative cerebrovascular accidents (CVA) after coronary artery bypass graft (CABG) surgery in diabetic patients. METHODS: This prospective observational study included 135 diabetic patients underwent coronary artery bypass graft surgery between January 2008 and August 2011. The participating patients were divided into two groups as: Group 1 (n=17) smokers and Group 2 (n=118) non-smokers. Preoperative risk analysis for estimating the post operative CVA was performed by using the criteria of American Heart Association (ACC/AHA) updated in 2004. According to the criteria, assumed postoperative CVA risks ranged between 0.6% and 2% (mean rate for all patients was 1.04±0.4%). Until the postoperative 60th day, all patients were integrated in a follow up programme to scan and diagnose a probable CVA. Patients with symptoms, signs and suspicions of CVA were evaluated by a series cranial tomography scanning and a multi-disciplinary approach in conjunction with the departments of radiology and neurology. Statistical analysis was performed using Student’s t test, Fischer’s exact test, Yates’ correction chi-square test and Mann-Whitney U test. A p value < 0.05 was considered statistically signifi cant. RESULTS: There were 83 male and 52 female participants. The number of males was signifi cantly higher than the females in both the smokers (88.2%) and the non-smokers groups (57.6%), (p< 0.05). The rate of the male patients in the smokers group was also signifi cantly higher than the rate of the smokers in the nonsmokers group (p< 0.05). The rate of patients with insulin dependent DM was 52.9% and 30.5% in the smokers and non-smokers group, respectively, however the inter group difference was not signifi cant (p> 0.05). The rate of preoperatively defi ned estimated postoperative CVA risk, intra-operative pump use and crossclamping durations did not show signifi cant differences between the smokers and non-smokers (p> 0.05). There were two postoperative CVA (11.8%) cases in the smokers and two CVA cases in the non-smokers (1.7%) groups. The rate of CVA was signifi cantly higher among the smokers in comparison with the non-smokers (p< 0.05). CONCLUSION: Smoking in the last six months before attending to the department of cardiovascular surgery for isolated CABG surgery increases the risk for post operative CVA in diabetic patients.

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