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(Stroke. 2007;38:2048.)
© 2007 American Heart Association, Inc.

Original Contributions

Neurocognitive Outcomes Are Not Improved by 17ß-Estradiol in Postmenopausal Women Undergoing Cardiac Surgery

Charles W. Hogue, Jr, MD; Kenneth Freedland, PhD; Tamara Hershey, PhD; Robert Fucetola, PhD; Abullah Nassief, MD; Benico Barzilai, MD; Betsy Thomas, RN; Stanley Birge, MD; David Dixon, MS; Kenneth B. Schechtman, PhD Victor G. Dávila-Román, MD

From the Department of Anesthesiology and Critical Care Medicine (C.W.H., Jr), Johns Hopkins University Medical School, Baltimore, Md; the Departments of Psychiatry (K.F., T.H., S.B.) and Neurology (R.F., A.N.), the Cardiovascular Division, Department of Medicine (B.B., V.G.D.-R.), the Department of Anesthesiology (B.T.), and the Division of Biostatistics, Department of Medicine (D.D., K.B.S.), Washington University School of Medicine, St. Louis, Mo.

Correspondence to Charles W. Hogue, Jr, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Tower 711, Baltimore, MD 21287. E-mail chogue2{at}jhmi.edu

Background and Purpose— Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17ß-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 17ß-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 17ß-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 17ß-estradiol (n=86) and those randomized to placebo (n=88) 4 to 6 weeks after surgery (17ß-estradiol, 22.4% versus placebo, 21.4%, P=0.45). The mean scores on tests of psychomotor speed were worse in women in the 17ß-estradiol group than in the placebo group at the 4- to 6-week (P=0.005) postoperative testing sessions.

Conclusions— Perioperative treatment with 17ß-estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery.

Key Words: cardiac surgery • cognitive impairment • estrogen • neuroprotective agents

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