Elsevier

American Heart Journal

Volume 172, February 2016, Pages 80-87
American Heart Journal

Clinical Investigation
Cerebrovascular accidents after percutaneous coronary interventions from 2002 to 2014: Incidence, outcomes, and associated variables

https://doi.org/10.1016/j.ahj.2015.10.019Get rights and content

Background

Cerebrovascular accident (CVA) and transient ischemic attack (TIA) related to percutaneous coronary intervention (PCI) are relatively rare complications, but they are associated with high morbidity and mortality. Given the evolution of both CVA risk and PCI techniques over time, this study was conducted to evaluate trends in CVA and TIA associated with PCI and to identify variables associated with neurologic events.

Methods

Consecutive patients undergoing PCI at the Washington Hospital Center between January 2002 and June 2015 were included. Prespecified data were prospectively collected, including baseline and procedural characteristics, in-hospital outcomes, and 1-year mortality. The subjects who had a CVA or TIA during or immediately after PCI were compared with those without procedure-associated CVA or TIA.

Results

Overall, 25,626 patients were included in the study. The mean age was 65.0 ± 12.4 years, 16,949 (65.2%) were male, and 7,436 (28.6%) were African American. From 2002 to 2015, 110 neurologic events post-PCI were diagnosed (0.43%); this included 86 CVAs (0.34%) and 24 TIAs (0.09%). The annual rate of postprocedural neurologic events was 0.42% ± 0.12%. There were significant changes in baseline risk factors over time, with increasing age, incidence of insulin-dependent diabetes, and chronic kidney disease. Patients with neurologic events were more often African American (43.6% vs 28.6%, P < .001) with prior history of CVA (24.5% vs 7.8%, P < .001), chronic renal insufficiency (26.6% vs 15.2%, P < .001), and insulin-dependent diabetes (19.1% vs 12.4%, P = .03). Acute myocardial infarction (56% vs 30.4%, P < .001) and cardiogenic shock (20.2% vs 3%, P < .001) were also more common among patients with neurologic events post-PCI. After multivariable adjustment, use of an intraaortic balloon pump was strongly associated with neurologic events (odds ratio [OR] 4.9, 95% CI 2.7-8.8, P < .001), as was prior CVA (OR 2.4, 95% CI 1.4-4.4, P = .002) and African American race (OR 2.4, 95% CI 1.5-3.9, P < .001); there was a borderline association with the use of a thrombus extraction device (OR 1.7, 95% CI 0.9-3.2, P = .09). In-hospital mortality (20.0% vs 1.5%, P < .001) and 1-year mortality (45.0% vs 7.3%, P < .001) were also much higher in patients with neurologic events.

Conclusion

Neurologic events post-PCI are associated with markedly worse in-hospital outcomes. The incidence of CVA and TIA post-PCI, however, remained stable over the last 12 years despite an increase in risk factors for CVA.

Section snippets

Methods

The present study is an observational, retrospective single-center analysis evaluating the incidence and the outcomes of periprocedural CVA and TIA related to PCI. Consecutive patients undergoing PCI at the Washington Hospital Center between January 2002 and June 2015 and with in-hospital neurologic outcomes available were included. Patients who received intravenous thrombolytic therapy were excluded from the analysis. The subjects who experienced CVA or TIA during or immediately after PCI were

Population characteristics

From January 2002 to June 2015, there were 25,626 patients with information available regarding CVA or TIA post-PCI and not receiving intravenous thrombolytics, who were included in this present study. The mean age was 65.0 ± 12.4 years, 65.2% were male, and 28.6% were African American. Overall, 110 patients had postprocedural CVA or TIA (0.43%) including 86 CVAs (0.34%) and 24 TIAs (0.09%). The incidence of CVA or TIA post-PCI remained constant from 2002 to 2015 (Figure 1) (P = .94), with an

Discussion

The present study describes several notable findings. First, the rate of post-PCI CVA or TIA in unselected patients was 0.42% ± 0.12%; this risk was stable from 2002 to 2015, despite the fact that most risk factors for stroke have increased in prevalence over the same time frame. Second, patients who experienced post-PCI CVA or TIA are more frequently African American and more frequently have a reduced LVEF and history of prior stroke, chronic renal insufficiency, and insulin-dependent

Conclusion

The incidence of post-PCI CVA and TIA is low and remained stable over the last 12 years, despite a steady increase in most risk factors for stroke. The outcomes of such patients remain abysmal, however, despite advances in the overall safety and efficacy of PCI. Further research is required to facilitate earlier diagnosis of CVA, and the relative utility of thrombolytics versus mechanical thrombectomy remains largely unexplored. Lastly, the increase in CVA among patients requiring an IABP and

References (19)

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