Cerebrovascular accidents after percutaneous coronary interventions from 2002 to 2014: Incidence, outcomes, and
Romain Didier1, Michael A Gaglia1, Edward Koifman1
1MedStar Washington Hospital Center, Washington, DC.
Insights
Neurologic events like stroke (CVA) and TIA after percutaneous coronary intervention (PCI) are rare but serious. Despite rising patient risk factors, the incidence of these events remained stable over 12 years.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Cerebrovascular accident (CVA) and transient ischemic attack (TIA) are rare but severe complications of percutaneous coronary intervention (PCI).
- These neurologic events are linked to significantly increased morbidity and mortality.
- Understanding trends and risk factors is crucial given evolving PCI techniques and patient demographics.
Purpose of the Study:
- To evaluate trends in CVA and TIA incidence following PCI.
- To identify patient and procedural variables associated with post-PCI neurologic events.
- To assess the impact of these events on patient outcomes.
Main Methods:
- A prospective study of 25,626 consecutive patients undergoing PCI between 2002 and 2015.
- Data collected included baseline characteristics, procedural details, in-hospital outcomes, and 1-year mortality.
- Patients experiencing CVA or TIA were compared to those without neurologic events.
Main Results:
- The overall incidence of post-PCI neurologic events was 0.43% (86 CVAs, 24 TIAs).
- Patients with neurologic events had higher rates of prior CVA, chronic kidney disease, diabetes, acute myocardial infarction, and cardiogenic shock.
- Intraaortic balloon pump use, prior CVA, and African American race were significantly associated with increased risk of neurologic events.
Conclusions:
- Post-PCI neurologic events are associated with substantially worse in-hospital and 1-year mortality.
- Despite increasing patient risk factors, the incidence of CVA and TIA post-PCI remained stable over the study period.
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.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care