Frequency of Stroke After Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting (from an Eleven-Year Statewide Analysis)

Moreyra, Abel E.; Maniatis, Gregory; Gu, Hui; Swerdel, Joel N.; McKinney, James S.; Cosgrove, Nora M.; Kostis, William J.; Kostis, John B.

doi:10.1016/j.amjcard.2016.09.046

Cited by 16 publications

(15 citation statements)

References 30 publications

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“…Although the mortality rate was similar in both periods (early period 1.1%, late period 1.4%, P = .692), adverse neurological events were more common in the later period (stroke: 1.8% vs 0%, P = .001; coma: 0.8% vs 0%, P = .04). Previous studies reported stroke rates range between 0.8% and 5.2% [2,17–20] and mortality rates between 1.5% and 6%. [2,21–26] Those findings were also observed after propensity score matching.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of coronary artery bypass surgery in a community hospital

Ziv‐Baran¹,

Mohr

Yazdchi

et al. 2019

Medicine

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Section: Discussionmentioning

confidence: 99%

The epidemiology of coronary artery bypass surgery in a community hospital

Ziv‐Baran¹,

Mohr

Yazdchi

et al. 2019

Medicine

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“…One limitation of the present study was that we lacked access to any intraoperative or perioperative data from the surgical procedure. Different surgical approaches reportedly have varying influences on the risk for postoperative IS 12,27 . Prolonged cardiopulmonary bypass time is consistently identified as a predictor of postoperative stroke after CABG; therefore, it would have been of interest to include procedural data in our analyses.…”

Section: Methodsmentioning

confidence: 99%

Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

Åström

Söderström

Mooe

2020

Sci Rep

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only sparse epidemiological data are available regarding the risk of ischemic stroke (iS) after coronary artery bypass surgery (cABG). Here we aimed to describe the incidence and predictors of iS associated with cABG performed after acute myocardial infarction (AMi), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5-17.1) and 10.9% (10.6-11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5-4.5) and 2.3% (2.2-2.3), respectively, among patients with and without cABG in the late cohort. predictors of post-AMi iS included prior iS, cABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo cABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce iS risk among cABG patients. Ischemic stroke (IS) is often a devastating event, carrying a high mortality rate and huge economic consequences for society 1,2. During the early period following an acute myocardial infarction (AMI), there is an increased risk of stroke, particularly stroke of ischemic origin 3. Although the mechanisms behind post-AMI IS are largely unknown, several risk factors have been identified, including older age, female sex, prior IS, prior diabetes mellitus, atrial fibrillation, chronic kidney disease, heart failure during hospitalization, and ST-elevation myocardial infarction (STEMI)0 4-7. The initial increased risk of IS after AMI seems to be associated with pro-thrombotic factors, such as platelet activation, inflammation, and sympathetic activation 1,8-10. Patients undergoing coronary artery bypass surgery (CABG) also show an increased risk of IS, with the majority of CABG-associated strokes occurring postoperatively 11. The most important risk factors for CABG-associated stroke include advanced age, prior cerebrovascular disease, prior carotid artery stenosis, prior peripheral vascular disease, prolonged cardiopulmonary bypass time, and postoperative atrial fibrillation 12,13. Undergoing CABG within the acute phase after AMI has also been identified as a risk factor for post-AMI IS 2,5. However, only limited data are available regarding the risk of IS associated with post-AMI CABG. There is a particular lack of long-term follow-up data and outcome data for patients undergoing CABG during a more stable post-AMI phase. To date, no predictors of IS in patients undergoing post-AMI CABG surgery have been conclusively identified, and additional knowledge is required to develop preventive measures. Over the last decade, the risk of IS after AMI has d...

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“…Moreover, CABG is indicated in severe coronary artery disease whereby PCI would not be useful, for example, in patients with severe LMCD, triple-vessel diseases, with associated conditions such as dialysis dependency, severe chronic obstructive pulmonary disease, and so on [32]. Nevertheless, when on-pump and off-pump CABG were considered, an 11-year statewide analysis from New Jersey showed on-pump CABG to be associated with significantly higher stroke compared to off-pump CABG [33].…”

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confidence: 99%

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis

Wang

Wei

et al. 2021

Diabetes Ther

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Introduction In this meta-analysis, we aimed to systematically compare the 10-year outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus (T2DM) suffering from left main coronary artery disease (LMCD). Methods Medical Literature Analysis and Retrieval System Online (MEDLINE), http://www.ClinicalTrials.gov , Excerpta Medica dataBASE (EMBASE), Cochrane Central, Web of Science, and Google scholar were searched for publications comparing 10-year outcomes of PCI versus CABG in patients with T2DM suffering from LMCD. Cardiovascular outcomes were considered as the clinical endpoints. Statistical analysis was carried out using RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after analysis. Results Eight studies (three randomized trials and five observational studies) with a total number of 3835 participants with T2DM were included in this analysis; 2340 participants were assigned to the PCI group and 1495 participants were assigned to the CABG group. Results of this analysis showed that mortality (RR 0.85, 95% CI 0.73–1.00; P = 0.05), myocardial infarction (RR 0.53, 95% CI 0.35–0.80; P = 0.002), repeated revascularization (RR 0.34, 95% CI 0.26–0.46; P = 0.00001), and target vessel revascularization (RR 0.26, 95% CI 0.18–0.38; P = 0.00001) were significantly higher with PCI when compared to CABG in these patients with diabetes and LMCD. Major adverse cardiac and cerebrovascular events were also significantly higher with PCI at 10 years (RR 0.67, 95% CI 0.49–0.92; P = 0.01). However, CABG was associated with a significantly higher risk of stroke (RR 2.16, 95% CI 1.39–3.37; P = 0.0007). Conclusions During a long-term follow-up time period of 10 years, PCI was associated with worse clinical outcomes compared to CABG in these patients with T2DM suffering from LMCD. However, a significantly higher risk of stroke was observed with CABG. This piece of information might be vital in order to carefully choose and prevent complications following revascularization in such patients.

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Frequency of Stroke After Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting (from an Eleven-Year Statewide Analysis)

Cited by 16 publications

References 30 publications

The epidemiology of coronary artery bypass surgery in a community hospital

The epidemiology of coronary artery bypass surgery in a community hospital

Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type 2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis

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