Acute Ischemic Stroke and Transient Ischemic Attack in ST-Segment Elevation Myocardial Infarction Patients Who...

Area of Science:

• Cardiology
• Neurology
• Interventional Cardiology

Background:

• Acute ischemic stroke (AIS) and transient ischemic attack (TIA) are rare but serious complications following ST-elevation myocardial infarction (STEMI).
• Invasive procedures like primary percutaneous coronary intervention (PCI) for STEMI may increase the risk of AIS/TIA.
• Identifying factors associated with in-hospital AIS/TIA in STEMI patients undergoing primary PCI is crucial for risk mitigation.

Purpose of the Study:

• To investigate the factors associated with in-hospital AIS/TIA in patients with STEMI who underwent primary PCI.
• To compare clinical outcomes between STEMI patients who developed AIS/TIA and those who did not.

Main Methods:

• A cohort of 941 STEMI patients undergoing primary PCI was analyzed.
• Patients were divided into an AIS/TIA group (n=39) and a non-AIS/TIA group (n=902).
• Multivariate logistic regression analysis was employed to identify associated factors.

Main Results:

• The incidence of in-hospital death was significantly higher in the AIS/TIA group (46.2%) compared to the non-AIS/TIA group (6.3%).
• Multivariate analysis identified cardiogenic shock, new-onset atrial fibrillation (AF), trans-femoral approach, use of ≥4 catheters, and BARC type 3 or 5 bleeding as significantly associated with AIS/TIA.
• These factors showed odds ratios ranging from 2.280 to 3.715.

Conclusions:

• New-onset AIS/TIA in STEMI patients undergoing primary PCI is significantly associated with cardiogenic shock, new-onset AF, trans-femoral approach, extensive catheter use, and major bleeding.
• Recognizing these modifiable and unmodifiable risk factors is essential for managing STEMI patients and preventing AIS/TIA.
• These findings highlight the need for careful procedural planning and patient monitoring during primary PCI for STEMI.