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Frequency and predictors of diagnostic coronary angiography and percutaneous coronary intervention related to stroke
Bartłomiej Staszczak1, Krzysztof P Malinowski2, Wojciech Wańha3
1Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
Insights
Percutaneous coronary interventions (PCI) ± diagnostic coronary angiography (DCA) procedures are linked to fewer stroke risk factors and lower stroke rates compared to isolated DCA. This large national registry study highlights procedural differences in stroke occurrence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Neurology
Background:
- Stroke is a rare but severe complication of percutaneous coronary interventions (PCIs).
- Understanding stroke incidence and predictors in coronary procedures is crucial for patient safety.
Purpose of the Study:
- To evaluate the association between coronary procedure type and stroke incidence.
- To identify predictors of stroke in patients undergoing diagnostic coronary angiography (DCA) and PCI.
Main Methods:
- Retrospective analysis of prospectively collected data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) (2014-2019).
- Included 1,177,161 coronary procedures: 650,674 isolated DCA and 526,487 PCI ± DCA.
- Multivariable logistic regression was used to identify stroke predictors.
Main Results:
- Periprocedural stroke occurred in 0.013% of patients (157/1,177,161).
- Isolated DCA had a higher stroke rate (0.015%) than PCI ± DCA (0.011%).
- Key predictors for DCA included prior stroke, contrast volume, femoral access, and older age. For PCI ± DCA, predictors included prior stroke, thrombolysis, bivalirudin, and aspirin loading.
Conclusions:
- PCI ± DCA procedures are associated with a lower incidence of periprocedural stroke compared to isolated DCA.
- Identifying specific predictors allows for targeted risk mitigation strategies in coronary angiography and PCI.
Background:
Stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, which can be potentially life-threatening and can lead to serious disability.
Aims:
This study aimed to assess the relationship between the type of coronary procedure and incidence of stroke, as well as its predictors.
Methods:
This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) between January 2014 and December 2019 and included 1177 161 coronary procedures. Among them, 650 674 patients underwent isolated diagnostic coronary angiography (DCA), and 526 487 PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) happened during DCA and 57 (0.011%) during PCI. Multivariable logistic regression analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI.
Results:
The percentage of patients with periprocedural stroke was higher in the group treated with isolated DCA during the analyzed time. Among predictors of stroke in patients undergoing DCA, we confirmed prior stroke (P <0.001), contrast amount (P = 0.007), femoral access (P = 0.002), unfractionated heparin use (P = 0.01), direct transport to the catheterization laboratory (P = 0.04), older age (P <0.001) and multi-vessel disease (P <0.001). While for PCI ± DCA, these were prior stroke (P <0.001), thrombolysis (P = 0.003), treatment with bivalirudin (P <0.001), and acetylsalicylic acid loading during PCI (P = 0.003).
Conclusions:
Based on the large national registry, PCI ± DCA is associated with fewer risk factors and a lower rate of periprocedural strokes than isolated DCA.
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