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

Background and Purpose—Neurocognitive dysfunction is an important source of patient morbidity and mortality after cardiac surgery that may disproportionately affect postmenopausal women. 17 -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 17 -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 17 -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 17 -estradiol (n 86) and those randomized to placebo (n 88) 4 to 6 weeks after surgery (17 -estradiol, 22.4% versus placebo, 21.4%, P 0.45). The mean scores on tests of psychomotor speed were worse in women in the 17 -estradiol group than in the placebo group at the 4to 6-week (P 0.005) postoperative testing sessions. Conclusions—Perioperative treatment with 17 -estradiol did not result in improved neurocognitive outcomes in postmenopausal women undergoing cardiac surgery. (Stroke. 2007;38:000-000.)