The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 4 , Pages 901-912 , April 2010

Predictive value of the National Institutes of Health Stroke Scale and the Mini-Mental State Examination for neurologic outcome after coronary artery bypass graft surgery

  • Nancy A. Nussmeier, MD

      Affiliations

    • Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, NY
    • Corresponding Author InformationAddress for reprints: Nancy A. Nussmeier, MD, SUNY Upstate Medical University (Syracuse, New York), c/o Editorial Office, Ischemia Research and Education Foundation, 1111 Bayhill Drive, Suite 480, San Bruno, CA 94066.
    • ,
  • Yinghui Miao, MD, MPH

      Affiliations

    • Ischemia Research and Education Foundation, San Bruno, Calif
    • ,
  • Gary W. Roach, MD

      Affiliations

    • Cardiovascular Anesthesia Group, Kaiser-Permanente, and the University of California, San Francisco, Calif
    • ,
  • Richard L. Wolman, MD

      Affiliations

    • Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, Wis
    • ,
  • Christina Mora-Mangano, MD

      Affiliations

    • Department of Anesthesia, Stanford University School of Medicine, Stanford, Calif
    • ,
  • Mark Fox, MD

      Affiliations

    • Department of Anaesthesia, The Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    • ,
  • Andrea Szekely, MD

      Affiliations

    • Department of Anesthesia, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungry
    • ,
  • Concezione Tommasino, MD

      Affiliations

    • Institute of Anesthesiology and Intensive Care, San Raffaele Hospital, and San Paolo University Hospital, Milan, Italy
    • ,
  • Nanette M. Schwann, MD

      Affiliations

    • Department of Anesthesiology, Lehigh Valley Hospital and Health Network, Allentown, Pa
    • ,
  • Dennis T. Mangano, MD, PhD

      Affiliations

    • Ischemia Research and Education Foundation, San Bruno, Calif
    • ,
  • Investigators of the Ischemia and Education Foundation and the Multicenter Study of Perioperative Ischemia Research Group

      Affiliations

    • A complete list of the investigators and participating centers of the Ischemia Research and Education Foundation and the Multicenter Study of Perioperative Ischemia Research Group is at the end of this article.

Received 19 August 2008 ,Revised 2 June 2009 ,Accepted 22 July 2009.

References 

  1. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20:864–870
  2. Lyden P, Raman R, Liu L, Grotta J, Broderick J, Olson S, et al. NIHSS training and certification using a new digital video disk is reliable. Stroke. 2005;36:2446–2449
  3. Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, et al. Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke. 2005;36:e100–e143
  4. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291:1720–1729
  5. Cook DJ, Huston J, Trenerry MR, Brown RD, Zehr KJ, Sundt TM. Postcardiac surgical cognitive impairment in the aged using diffusion-weighted magnetic resonance imaging. Ann Thorac Surg. 2007;83:1389–1395
  6. Shernan SK, Fitch JC, Nussmeier NA, Chen JC, Rollins SA, Mojcik CF, et al. Impact of pexelizumab, an anti-C5 complement antibody, on total mortality and adverse cardiovascular outcomes in cardiac surgical patients undergoing cardiopulmonary bypass. Ann Thorac Surg. 2004;77:942–949
  7. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198
  8. Hensel A, Angermeyer MC, Riedel-Heller SG. Measuring cognitive change in older adults: reliable change indices for the Mini-Mental State Examination. J Neurol Neurosurg Psychiatry. 2007;78:1298–1303
  9. Fitch JC, Rollins S, Matis L, Alford B, Aranki S, Collard CD, et al. Pharmacology and biological efficacy of a recombinant, humanized, single-chain antibody C5 complement inhibitor in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. Circulation. 1999;100:2499–2506
  10. Weissrock S, Levy F, Balabaud V, Thiranos JC, Dupeyron JP, Steib A. [Interest of the Mini Mental State Examination to detect cognitive defects after cardiac surgery]. Ann Fr Anesth Reanim. 2005;24:1255–1261
  11. Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med. 1996;335:1857–1863
  12. Mangano DT. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002;347:1309–1317
  13. Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989;46:660–662
  14. Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale: extension to non-neurologists in the context of a clinical trial. Stroke. 1997;28:307–310
  15. Vickers AJ, Altman DG. Statistics notes: analyzing control trials with baseline and follow-up measurements. BMJ. 2001;323:1123–1124
  16. O'Bryant SE, Humphreys JD, Smith GE, Ivnik RJ, Graff-Radford NR, Petersen RC, et al. Detecting dementia with the mini-mental state examination in highly educated individuals. Arch Neurol. 2008;65:963–967
  17. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922–935
  18. Lyden P, Lu M, Jackson C, Marler J, Kothari R, Brott T, et al. Underlying structure of the National Institutes of Health Stroke Scale: results of a factor analysis. NINDS tPA Stroke Trial Investigators. Stroke. 1999;30:2347–2354
  19. Tong DC, Yenari MA, Albers GW, O'Brien M, Marks MP, Moseley ME. Correlation of perfusion and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology. 1998;50:864–870
  20. Wkhloo AK, Sandhu JS. Principles of endovascular therapy. In:  Bradley WG,  Daroff RB,  Fenichel GM,  Jancovic J editor. Neurology in clinical practice: principles of diagnosis and management. 4th ed. Philadelphia: Elsevier; 2004;p. 993–1025
  21. Adams HP, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999;53:126–131
  22. Young FB, Weir CJ, Lees KR. Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials. Stroke. 2005;36:2187–2192
  23. Bruno A, Saha C, Williams LS. Using change in the National Institutes of Health Stroke Scale to measure treatment effect in acute stroke trials. Stroke. 2006;37:920–921
  24. Spreen O, Strauss E. A compendium of neuropsychological tests: administration, norms, and commentary. 2nd ed. New York: Oxford University Press; 1998;
  25. Tombaugh TN, McDowell I, Kristjansson B, Hubley AM. Mini-Mental State Examination (MMSE) and the Modified MMSE (3MS): a psychometric comparison and normative data. Psychol Assess. 1996;8:48–59
  26. Foster JR, Sclan S, Welkowitz J, Boksay I, Seeland I. Psychiatric assessment in medical long-term care facilities: reliability of commonly used rating scales. Int J Geriatr Psychiatry. 1988;3:229–233
  27. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269:2386–2391
  28. Baker R, Hallsworth LJ, Knight RB. Stroke after coronary artery bypass grafting. Ann Thorac Surg. 2005;80:1746–1750
  29. Anyanwu AC, Filsoufi F, Salzberg SP, Bronster DJ, Adams DH. Epidemiology of stroke after cardiac surgery in the current era. J Thorac Cardiovasc Surg. 2007;134:1121–1127
  30. Lisle TC, Barrett KM, Gazoni LM, Swenson BR, Scott CD, Kazemi A, et al. Timing of stroke after cardiopulmonary bypass determines mortality. Ann Thorac Surg. 2008;85:1556–1563
  31. Salis S, Mazzanti VV, Merli G, Salvi L, Tedesco CC, Veglia F, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22:814–822
  32. Dafer RM. Risk estimates of stroke after coronary artery bypass graft and carotid endarterectomy. Neurol Clin. 2006;24:795–806
  33. Selnes OA, Grega MA, Bailey MAM, Pham LD, Zeger SL, Baumgartner WA, et al. Cognition 6 years after surgical or medical therapy for coronary artery disease. Ann Neurol. 2008;63:581–590

 Disclosures: None.

PII: S0022-5223(09)01005-8

doi: 10.1016/j.jtcvs.2009.07.055

The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 4 , Pages 901-912 , April 2010

Article Tools

* Image Usage & Resolution