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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Stroke complicating percutaneous coronary intervention in patients with acute myocardial infarction
Akio Kawamura1, Daniel A Lombardi, Matthew E Tilem
1Department of Cardiovascular Medicine, Keio University School of Medicine, Tokyo, Japan. kawamura@cpnet.med.keio.ac.jp
Insights
Stroke following percutaneous coronary intervention (PCI) remains a serious complication. Low ejection fraction is a key predictor, but periprocedural stroke risk factors differ from later events.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Stroke is a devastating complication of percutaneous coronary intervention (PCI).
- The incidence of stroke during PCI has remained unchanged despite advancements.
- Understanding stroke risk factors in myocardial infarction (MI) patients undergoing PCI is crucial.
Purpose of the Study:
- To determine the incidence of stroke in patients with MI undergoing PCI.
- To identify independent predictors and correlates of stroke in this patient population.
Main Methods:
- Retrospective analysis of 2,281 consecutive patients undergoing PCI for MI (STEMI and non-STEMI).
- Stroke defined as new focal neurological deficit > or =24 hours from PCI until discharge.
- Multivariate logistic regression analysis to identify stroke predictors.
Main Results:
- The overall stroke incidence was 0.88% (20 strokes), with 95% being ischemic.
- Low ejection fraction (< or =30%) was the sole independent predictor of stroke (OR=4.3, p=0.003).
- Periprocedural stroke (<24h) was associated with vein graft PCI and less frequent glycoprotein IIb/IIIa inhibitor use, while later stroke (>24h) correlated with diabetes, renal dysfunction, and anterior STEMI.
Conclusions:
- Low ejection fraction is a significant independent predictor for stroke post-PCI.
- Risk factors for early (<24h) and late (>24h) post-PCI stroke differ.
- Early upstream use of glycoprotein IIb/IIIa inhibitors may reduce periprocedural stroke risk.
Background:
Stroke associated with percutaneous coronary intervention (PCI) is a tragic complication. Despite advances in the practice of PCI, the incidence of stroke complicating PCI has not changed over the decades. The objective of the present study was to evaluate incidence and correlates of stroke occurring in patients with myocardial infarction (MI) undergoing PCI.
Methods And Results:
Stroke was defined as the presence of any new focal neurological deficit lasting > or =24 h that occurred anytime during or after PCI until discharge. In 2,281 consecutive patients with PCIs for non-ST-elevation MI, or ST-elevation MI (STEMI), 20 strokes were identified (0.88%). Strokes were ischemic in 95%. On multivariate analyses, ejection fraction < or =30% (odds ratio =4.3, p=0.003) was the only independent predictor for stroke. In patients who developed stroke within 24 h of PCI, PCI of vein grafts was more frequent, and use of glycoprotein IIb/IIIa inhibitor was less frequent. Those patients tended to present late in the course of MI. Stroke found more than 24 h after PCI was related to diabetes, higher serum creatinine, lower ejection fraction, anterior wall STEMI and emergency use of intra-aortic balloon pumps.
Conclusions:
Low ejection fraction was the only independent predictor for stroke, but risk factors for periprocedural stroke are different from those of stroke occurring more than 24 h after PCI. Upstream use of glycoprotein IIb/IIIa inhibitor might decrease the risk of periprocedural stroke.
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