Neurocognitive outcomes are not improved by 17beta-estradiol in postmenopausal women undergoing cardiac surgery.

Author(s): Hogue CW Jr, Freedland K, Hershey T, Fucetola R, Nassief A, Barzilai B, Thomas B, Birge S, Dixon D, Schechtman KB, Davila-Roman VG

Affiliation(s): Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA. chogue2@jhmi.edu

Publication date & source: 2007-07, Stroke., 38(7):2048-54. Epub 2007 May 17.

Publication type: Randomized Controlled Trial; Research Support, N.I.H., Extramural

BACKGROUND AND PURPOSE: Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17beta-Estradiol limits the extent of ischemic neuronal injury in a variety of experimental models. The purpose of this study was to evaluate whether perioperative administration of 17beta-estradiol to postmenopausal women reduces the frequency of neurocognitive dysfunction after cardiac surgery. METHODS: One hundred seventy-four postmenopausal women not on estrogen replacement therapy who were undergoing primary coronary artery bypass graft surgery and/or valve surgery with cardiopulmonary bypass were prospectively randomized to receive in a double-blinded manner either 17beta-estradiol or placebo beginning the day before surgery and continuing for 5 days postoperatively. The patients were evaluated before and after surgery with the National Institutes of Health Stroke Scale and a psychometric test battery. RESULTS: There were no differences in the frequency of neurocognitive dysfunction (primary outcome) between patients randomized to perioperative 17beta-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17beta-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17beta-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions. CONCLUSIONS: Perioperative treatment with 17beta-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.