Brief Report Assessment of Long-Term Cognitive Impairment After Off-Pump Coronary-Artery Bypass Grafting and Related Risk Factors Luis M. Pérez-Belmonte MD, PhD a, b, *, Carlos M. San Román-Terán MD, PhD c , Manuel Jiménez-Navarro MD, PhD a , Miguel A. Barbancho MD, PhD b , José M. García-Alberca MD, PhD d , José P. Lara MD, PhD b a CMU (Clinical Management Unit) of Heart Department, Virgen de la Victoria University Hospital, Málaga, Spain b Unit of Cognitive Neurophysiology, Research Medical Center of Málaga University, ICE (International Campus of Excellence) Andalucía Tech, BRIM (Biomedical Research Institute of Málaga), Málaga, Spain c Department of Internal Medicine, Axarquía County Hospital, Vélez-Málaga, Málaga, Spain d Department of Psychiatry, Unit of Dementia, Andalusia Institute of Neuroscience and Conduct, Málaga, Spain Keywords: Postoperative cognitive impairment cognitive domain risk factors predictors of cognitive impairment off-pump coronary-artery bypass grafting abstract Objectives: To assess cognitive impairment after off-pump coronary-artery bypass grafting, with a particular emphasis on long-term follow-up and related risk factors. Design: Prospective study. Setting: Virgen de la Victoria University Hospital, Málaga, Spain. Participants: Participants were 36 patients undergoing off-pump coronary-artery bypass grafting. Measurements: Changes in the neuropsychological test battery administered from before to after surgery (1, 6, and 12 months). Postoperative cognitive impairment was defined by a significant decrease. Results: A significantly multidomain (attention-executive functions, P < .01; immediate and delayed memory, P < .001; and verbal fluency, P < .05) postoperative cognitive impairment was shown, being maximum at 6 months (more than 50% of patients) and still presented at 12 months (more than 30% of patients), but partially recovered. Related risk factors as smoking (P < .01), diabetes mellitus (P < .01), peripheral arteriopathy (P < .01), obesity (P < .05), lower hematocrit (P < .01), and hemoglobin (P < .05) levels and diastolic blood pressure (P < .05) were identified as predictors of cognitive impairment. Better New York Heart Association class (P < .01) and less severity of angina (P < .01) were associated with partial postoperative recovering. Conclusion: A multidomain long-term postoperative cognitive impairment and a partial neurocognitive recovering were detected after off-pump coronary-artery bypass grafting and were associated with several nonspecific surgery factors. These findings may be useful when counseling patients before sur- gery and suggest the importance of long-term neurocognitive evaluation. Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. Coronary-artery bypass grafting (CABG) is one of the most commonly performed procedures in patients with extensive coronary- artery disease. 1 Postoperative cognitive impairment (PCI) may be an important complication after this surgery. It is defined as a decline in performance on neuropsychological tests relative to preoperative levels and important cognitive domains (execute functions, attention, memory, and visuospatial perception) could be affected. 2,3 The inci- dence ranges of PCI varies from 20% to 80%, 3,4 and these defects are not always transient but may remain months or years after surgery. 2,4 Specific factors of cardiac surgery and anesthesia have been shown to be associated with PCI, 2,4,5 but much is still unknown with respect to other potential risk factors and mechanisms of cognitive dysfunction after cardiac surgery. 5,6 The purposes of this study were to determine the presence of PCI after off-pump CABG, with a particular emphasis on long-term follow-up and involved risk factors. Materials and Methods Thirty-six patients scheduled for elective off-pump CABG at Virgen de la Victoria University Hospital were prospectively enrolled between May 2012 and October 2013. The study was approved by the institutional research ethics committee and all patients gave written informed consent. A wide range of sociodemographic, clinical, and The authors declare no conflicts of interest. * Address correspondence to Luis M. Pérez-Belmonte, MD, PhD, Centro de Investigaciones Médico-Sanitarias (CIMES), Calle Marqués de Beccaria, número 3, Código postal: 29010, Málaga, Spain. E-mail address: luismiguelpb@hotmail.com (L.M. Pérez-Belmonte). JAMDA journal homepage: www.jamda.com http://dx.doi.org/10.1016/j.jamda.2014.12.001 1525-8610/Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. JAMDA 16 (2015) 263.e9e263.e11