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

Abel E Moreyra1, Gregory A Maniatis1, Hui Gu1

  • 1Cardiovascular Institute and the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

The American Journal of Cardiology
|November 8, 2016
PubMed

Insights

Drug-eluting stents (DES) had the lowest stroke risk among cardiac procedures. Off-pump coronary artery bypass grafting (CABG) showed lower stroke rates than on-pump CABG, with implications for 1-year mortality.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common revascularization strategies.
  • On-pump CABG, off-pump CABG, PCI with drug-eluting stents (DES), and PCI with bare-metal stents (BMS) have varying risk profiles.
  • Understanding procedural stroke risk and mortality impact is crucial for patient management.

Purpose of the Study:

  • To compare stroke rates and 30-day/1-year all-cause mortality across different revascularization procedures.
  • To evaluate the comparative effectiveness of on-pump CABG, off-pump CABG, PCI with DES, and PCI with BMS regarding stroke incidence.
  • To assess the interaction between stroke occurrence and procedure type on long-term mortality.

Main Methods:

  • Retrospective analysis of the Myocardial Infarction Data Acquisition System database (2002-2012).
  • Inclusion of patients undergoing on-pump CABG (n=47,254), off-pump CABG (n=19,118), PCI with BMS (n=46,641), and PCI with DES (n=115,942).
  • Utilization of multiple logistic and Cox proportional hazard models with adjustments for demographics, year, and comorbidities.

Main Results:

  • Postprocedural stroke rates were: DES (0.5%), BMS (0.6%), off-pump CABG (1.3%), and on-pump CABG (1.8%).
  • On-pump CABG demonstrated a significantly higher stroke risk compared to off-pump CABG (OR 1.36).
  • DES showed a lower stroke risk compared to off-pump CABG (OR 0.64).
  • A significant interaction between stroke and procedure type affected 1-year mortality (p=0.02).

Conclusions:

  • PCI with DES is associated with the lowest postprocedural stroke rate.
  • Off-pump CABG offers a lower stroke risk profile than on-pump CABG.
  • On-pump CABG and PCI with DES showed an excess 1-year mortality risk in patients experiencing stroke, highlighting the importance of stroke prevention in cardiac procedures.

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