Related Experiment Video
Updated: Jan 21, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Incidence, Predictors, and Outcomes of Acute Ischemic Stroke Following Percutaneous Coronary Intervention
Mohamad Alkhouli1, Fahad Alqahtani2, Abdulrahman Tarabishy3
1Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota.
Insights
The incidence of ischemic stroke after percutaneous coronary intervention (PCI) increased significantly from 2003 to 2016. This rise in post-PCI stroke is linked to higher mortality, longer hospital stays, and increased costs.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Health Services Research
Background:
- Limited contemporary data exists on ischemic stroke incidence and outcomes following percutaneous coronary intervention (PCI).
- Understanding these trends is crucial for improving patient care and outcomes in interventional cardiology.
Purpose of the Study:
- To evaluate temporal trends in post-PCI ischemic stroke incidence.
- To identify predictors of ischemic stroke after PCI.
- To assess the impact of post-PCI stroke on in-hospital outcomes, including mortality, length of stay, and cost.
Main Methods:
- Utilized the National Inpatient Sample database (2003-2016) to identify patients undergoing PCI.
- Calculated the incidence of post-PCI ischemic stroke and analyzed its predictors.
- Compared in-hospital outcomes between patients with and without post-PCI stroke using propensity score matching.
Main Results:
- Adjusted incidence of post-PCI ischemic stroke rose from 0.6% to 0.96% for STEMI, 0.5% to 0.6% for NSTEMI, and 0.3% to 0.72% for unstable/stable angina (p<0.001).
- Strong predictors included carotid disease, cardiogenic shock, atrial fibrillation, and older age. Higher rates were observed at lower-volume centers.
- Post-PCI stroke significantly increased in-hospital mortality (e.g., 23.5% vs. 11.0% in STEMI), length of stay (>2-fold), and cost (>60%).
Conclusions:
- The incidence of post-PCI ischemic stroke has significantly increased, potentially due to increasing patient complexity.
- Further research is essential to identify the drivers of this trend and develop effective mitigation strategies.
- Interventions aimed at reducing post-PCI stroke are critical for improving patient outcomes and healthcare resource utilization.
Objectives:
The aim of this study was to assess temporal trends in the incidence of ischemic stroke among patients undergoing percutaneous coronary intervention (PCI), predictors of post-PCI ischemic stroke, and the impact of post-PCI ischemic stroke on in-hospital morbidity, mortality, length of stay, and cost.
Background:
Data on the incidence and outcomes of ischemic stroke in patients undergoing PCI in the contemporary era are limited.
Methods:
The National Inpatient Sample was used to identify patients who underwent PCI between January 1, 2003, and December 31, 2016. The incidence of post-PCI ischemic stroke was calculated, and its predictors were assessed. In-hospital outcomes of patients with and those without post-PCI stroke were also compared.
Results:
The adjusted incidence of post-PCI ischemic stroke increased during the study period from 0.6% to 0.96% following PCI for ST-segment elevation myocardial infarction, from 0.5% to 0.6% following PCI for non-ST-segment elevation myocardial infarction, and from 0.3% to 0.72% following PCI for unstable angina or stable ischemic disease (ptrend <0.001). Carotid disease, cardiogenic shock, atrial fibrillation, and older age were the strongest predictors of post-PCI ischemic stroke. Post-PCI stroke rates were lower at high-volume versus low- to intermediate-volume centers. Thrombolytics, cerebral angiography, and mechanical thrombectomy use increased over time but remained infrequent. After propensity score matching, in-hospital mortality was higher among patients with post-PCI stroke (23.5% vs. 11.0%, 9.5% vs. 2.8%, and 11.5% vs. 2.4% in the ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina or stable ischemic heart disease cohorts, respectively; p < 0.001). Post-PCI stroke was associated with a >2-fold increase in length of stay, a >3-fold increase in nonhome discharges, and a >60% increase in cost.
Conclusions:
The incidence of post-PCI ischemic stroke increased significantly over the past decade, partially because of the increasing complexity of patients undergoing PCI over time. Further studies are needed to systematically assess contributors to this worrisome trend and to identify effective strategies for its mitigation.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:08Prevalence and Incidence
Prevalence indicates the proportion of individuals in a population who have a specific disease or health...