Aim: To develop a prognostic model and identify risk factors that may lead to cognitive decline 5-7 years after coronary artery bypass surgery.
Materials and methods. The observational prospective study included 146 patients with an average follow-up period of 6.4 years. The patients underwent general clinical, neurological, and instrumental examinations 3-5 days before and 5-7 years after surgery. Neuropsychological testing included assessment of psychomotor and executive functions, attention, and short-term memory. The method of binary logistic regression was used to build a predictive model.
Results. Cognitive decline, characterized by a≥20% decrease in postoperative cognitive indicators compared to the preoperative level in ≥20% of the total test battery, was detected 5-7 years after surgery in 67 (45.9%) patients. Neurodynamic disorders occurred in 60% of patients, while violations of verbal and symbolic short–term memory occurred in 20-25% of cases. It was found that the presence of carotid artery stenosis (CA), smoking, low ejection fraction, and high triglyceride levels are associated with the development of cognitive decline 5-7 years after CABG. With the initial cut-off threshold (0.5), the most effective ratio of sensitivity (0.61) and specificity (0.82) was selected, which ensures the successful determination of both the presence and absence of cognitive decline and indicates the good quality of the predictive model.
Conclusion. Five to seven years after CABG surgery, 46% of patients experience a decrease in cognitive functions, manifested in the form of neurodynamic disorders, as well as deterioration of short-term memory. The factors included in the prognostic model were CA stenosis, low left ventricular ejection fraction, and high triglyceride levels, as well as smoking in patients. This indicates the need to improve approaches to postoperative follow-up of patients who have undergone cardiac surgery to minimize adverse neurological consequences.