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Objective Advances in surgical, anaesthetic and percutaneous interventional techniques may have led to higher risk patients being referred for coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the predicted mortality risk (EuroSCORE) of a contemporary cohort of patients referred for isolated elective CABG (2002) with that of a cohort referred five years previously (1997) and to examine temporal trends in patient demographics. Methods Records (n = 2873) of weekly cardiac surgical referral meetings were examined and the age, sex, type of operation and surgical decision for every patient referred from 1997 to 2002 inclusive were recorded. Furthermore samples of patients referred in 1997 (n = 111) and in 2002 (n = 110) were chosen, and a complete EuroSCORE was calculated for each patient and compared between groups. Results In both 1997 and 2002 the median EuroSCORE among patients not accepted for surgery was significantly higher than those accepted (1997; 3 vs 2, p

Background: Studies of neuropsychological outcome following coronary artery bypass graft surgery (CABG) have traditionally dichotomised patients as "impaired" or "unimpaired". This conceals the potential heterogeneity of deficits due to different mechanisms and sites of brain injury. Objectives: To explore neuropsychological outcome following CABG and determine to what extent it conforms to prototypic cortical and/or subcortical neurobehavioral syndromes and whether different intraoperative physiologic measures are associated with different subtypes of neuropsychological outcome. Methods: Neuropsychological tests were administered to 85 patients before and after elective CABG and to 50 matched normal control subjects. Pre- to postoperative change scores were computed using standardised regression based norms. Change scores on selected memory measures were subjected to cluster analysis to identify qualitatively distinct subtypes of memory outcome. Emergent clusters were compared on non-memory measures, intraoperative physiologic measures, and demographic variables. Results: Three subtypes of memory outcome were identified: memory spared (48% of patients), retrieval deficit (35%), and encoding/storage deficit (17%). Contrary to expectation, the subgroups were indistinguishable on measures of confrontation naming and manual dexterity and on intraoperative cardiac surgical physiologic measures and demographic variables. The encoding/storage deficit subgroup exhibited executive dysfunction. Conclusions: Heterogeneous profiles of neuropsychological dysfunction were found following CABG although they did not tightly conform to prototypic cortical and subcortical neurobehavioral syndromes. This challenges the value and appropriateness of the common practice of collapsing individual test scores to arrive at a single figure to define "impairment". Whether different subtypes of neuropsychological outcome are caused by different pathophysiologic mechanisms remains unknown.