Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication

Abstract

Background and Purpose-Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented. Methods-The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization). Results-A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively. Conclusions-Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.

Incidence, predictors and impact of stroke on mortality among patients with acute coronary syndromes following percutaneous coronary intervention—Results from the PROMETHEUS registry

“…Multiple studies have demonstrated that stroke occurrence post‐PCI increased subsequent mortality by a considerable margin . The finding in our analysis is consistent with these studies.…”

CHA2DS2-VASc score as predictor of ischemic stroke in patients undergoing coronary artery bypass grafting and percutaneous coronary intervention

“…In this study, CHA 2 DS 2 -VASc score was significantly associated with the risk of post-procedural ischemic stroke following PCI. Although the predictive value of CHA 2 DS 2 -VASc score in predicting ischemic stroke following PCI is less established, the individual components of the CHA 2 DS 2 -VASc score have been demonstrated to represent significant risk factors for post-procedural ischemic stroke 27 , 28 . For example, an analysis of 426,046 patients undergoing PCI in England and Wales between 2007 and 2012 in the British Cardiovascular Intervention Society (BCIS) database demonstrated that age, female gender, a history of stroke were significant predictors of post-procedural ischemic stroke/TIA, and ischemic stroke was independently associated with both 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and revascularization) 27 .…”

Neuroinflammatory Mechanisms in Ischemic Stroke: Focus on Cardioembolic Stroke, Background, and Therapeutic Approaches

“…We can observe that cardiac thrombi are often created in the ventricular portion that is dikinetic after previous cardiac ischemia. Additionally, the standard gold treatment for the acute cardiac ischemia, the percutaneous coronary intervention, has an intrinsic risk for ischemic stroke of ≈0.1% with the modern techniques [ 136 ]. Nowadays, better methods of reperfusion, the knowledge of the relevance of the antiplatelet therapy, and the optimized medical therapy for the secondary prevention have reduced the risk of cerebral ischemia compared to the past [ 137 ].…”