Mortality of patients with previous stroke undergoing drug-eluting stent implantation

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• An increasing number of patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have a history of stroke.
• Limited data exist on the impact of prior stroke on outcomes following PCI with DES.

Purpose of the Study:

• To investigate the association between previous stroke and the risk of mortality in patients with coronary artery disease undergoing PCI with DES.
• To evaluate the influence of prior stroke on various adverse cardiovascular and cerebrovascular events.

Main Methods:

• A patient-level meta-analysis was conducted using data from three real-world PCI registries.
• A total of 18,650 patients with coronary artery disease who underwent PCI with DES were included in the study.
• The primary outcome was all-cause mortality, with secondary outcomes including cardiac death, myocardial infarction, stent thrombosis, stroke, and repeat revascularization.

Main Results:

• Patients with a previous stroke (n=1361) were older and had more comorbidities compared to those without (n=17,289).
• At a median follow-up of 47.0 months, previous stroke was associated with a significantly higher risk of all-cause death (adjusted HR=1.623) and cardiac death (adjusted HR=1.686).
• A substantially increased risk of recurrent stroke was observed in patients with prior stroke (adjusted HR=2.456), while risks for myocardial infarction, stent thrombosis, and repeat revascularization were not significantly different.

Conclusions:

• Previous stroke is an independent risk factor for increased all-cause mortality and recurrent stroke after PCI with DES.
• Healthcare providers should consider a history of stroke as a critical risk factor when managing patients undergoing PCI with DES.