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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Ischaemic stroke complicating primary percutaneous coronary intervention in patients with ST elevation myocardial

Mehmet Ergelen1, Sevket Gorgulu, Huseyin Uyarel

  • 1Dept. of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Training and Research Hospital, Istanbul, Turkey. drmerg@hotmail.com

Acta Cardiologica
|February 5, 2010
PubMed

Insights

Ischaemic stroke occurs in 0.73% of ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), increasing mortality. Low ejection fraction and contrast nephropathy predict stroke, while tirofiban may offer protection.

Area of Science:

  • Cardiology
  • Neurology
  • Interventional Cardiology

Background:

  • ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
  • Primary percutaneous coronary intervention (PCI) is the standard treatment for STEMI.
  • Ischaemic stroke is a serious complication that can occur during or after PCI.

Purpose of the Study:

  • To determine the in-hospital incidence of ischaemic stroke in STEMI patients undergoing primary PCI.
  • To identify predictors of ischaemic stroke in this patient population.
  • To assess the impact of ischaemic stroke on in-hospital cardiovascular mortality.

Main Methods:

  • Retrospective review of 2638 consecutive STEMI patients undergoing 2722 primary PCI procedures.
  • Definition of ischaemic stroke: new focal neurological deficit lasting > or =24 hours, excluding haemorrhagic stroke.
  • Analysis of clinical characteristics and in-hospital outcomes related to ischaemic stroke.

Main Results:

  • Ischaemic stroke incidence was 0.73% (20/2722 procedures).
  • Stroke patients were older, with higher prevalence of female gender, diabetes, and hypertension.
  • Independent predictors for ischaemic stroke included left ventricular ejection fraction (LVEF) < 35% and contrast-induced nephropathy; tirofiban use showed a protective effect.

Conclusions:

  • Ischaemic stroke incidence in STEMI patients undergoing PCI is significant and associated with increased in-hospital mortality.
  • Low LVEF (<35%) and contrast-induced nephropathy are independent predictors of ischaemic stroke.
  • Tirofiban use may have a protective role against ischaemic stroke in STEMI patients undergoing PCI.
Abstract

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