Randomized comparison of the clinical outcome of single versus multiple arterial grafts: cognition (roma:COG) - 1 project summary/abstract 2 3 coronary heart disease affects over 18.2 million…

Randomized comparison of the clinical outcome of single versus multiple arterial grafts: cognition (roma:COG) - 1 project summary/abstract 2 3 coronary heart disease affects over 18.2 million americans and coronary artery bypass surgery (CABG) is the 4 most common cardiac surgery in adults. Unfortunately, CABG is associated with stroke, cognitive impairment, 5 and dementia, especially among women and patients with diabetes. As many as 25% of patients with a clinically 6 uncomplicated postoperative course have evidence of brain emboli after CABG, and even small infarcts can 7 unmask latent neurodegeneration and increase postoperative cognitive impairment. Intraoperative 8 thromboembolism is one of the mechanisms contributing to cognitive impairment, due to surgical aortic 9 manipulation. Less aortic manipulation is associated with less plaque dislodgement, resulting in fewer embolic 10 events during cardiac surgery. The randomized comparison of the clinical outcome of single versus 11 multiple arterial grafts: cognition (roma:COG) study will identify both the global impact of CABG surgery 12 and the impact of acute infarction on cognitive function. The first aim addresses the impact of CABG surgical 13 technique on long-term cognitive function in an international cohort of 2,000 participants who have been 14 randomized to either a multiple arterial grafts or single arterial grafts groups and by important subgroups, 15 including women and patients with diabetes. Results will either demonstrate differences in cognitive function or 16 provide reassurance to cardiac surgeons that there are no differences in the proportion of patients with cognitive 17 impairment by surgical technique. In the second and third aims, the short-term impact of CABG surgical 18 technique will be determined based on domains of cognitive performance, and the associations among CABG 19 surgical technique, cognitive performance, brain infarction and novel serum biomarkers of brain health in a 20 cohort of 280 participants. Results will provide US with mechanistic details on the relationships between surgical 21 technique, detailed cognitive performance, acute MRI indicated brain infarction, and novel biomarkers of brain 22 health. Leveraging the international roma trial infrastructure, one of the largest cardiac surgery trials to date, 23 we have an unprecedented opportunity to clarify the impact of CABG surgical technique on short and long-term 24 cognitive function. Preventing postoperative cognitive impairment is an important public health concern that 25 could be mitigated with specific surgical techniques. The roma:COG study will help to identify people who could 26 benefit from detailed cognitive evaluation and early interventions, and will establish whether serum biomarkers 27 can be used as novel surrogate end-points in future studies to prevent vascular cognitive impairment.