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Updated: Aug 8, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Determinants and clinical outcomes of stroke following revascularization among patients with reduced ejection
Shaoping Wang1, Yuhua Ran2, Shujuan Cheng1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Insights
Stroke after heart revascularization is a serious risk for patients with reduced ejection fraction (EF). Older age, hypertension, and prior stroke increase stroke risk, leading to higher heart failure hospitalization rates.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Stroke is a rare but severe complication following cardiac revascularization procedures like percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
- Patients with reduced ejection fraction (EF) face a heightened risk of stroke post-revascularization, yet the specific factors and consequences remain underexplored.
Purpose of the Study:
- To identify predictors of stroke in patients with preoperative reduced EF undergoing revascularization.
- To evaluate the clinical outcomes associated with stroke in this high-risk patient population.
Main Methods:
- A cohort study analyzed 1937 patients with EF ≤40% who underwent PCI or CABG between 2005 and 2014.
- Multivariate logistic regression identified independent correlates of stroke and assessed its association with clinical outcomes.
Main Results:
- The incidence of stroke was 5.7% (111 patients) over a median follow-up of 3.5 years.
- Independent predictors of stroke included older age, history of hypertension, and prior stroke.
- While all-cause mortality was similar, stroke significantly increased the risk of heart failure hospitalization and composite endpoints.
Conclusions:
- Older age, hypertension, and prior stroke are key risk factors for stroke in patients with reduced EF undergoing revascularization.
- Stroke following revascularization in this cohort is associated with worse outcomes, particularly increased heart failure hospitalizations.
- Further research is crucial to develop strategies for mitigating stroke risk and improving long-term outcomes in these vulnerable patients.
Objective:
Stoke after revascularization including both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is an uncommon but devastating complication. Patients with reduced ejection fraction (EF) had an increased risk of stroke after revascularization. However, little is known about the determinants and outcomes of stroke among patients with reduced EF following revascularization.
Materials And Methods:
A cohort study of patients with preoperative reduced EF (≤40%) who received revascularization by either PCI or CABG between January 1, 2005 and December 31, 2014 was performed. Multivariate logistic regression was used to identify independent correlates of stroke. Logistic regression models were applied to evaluate the association of stroke with clinical outcomes.
Results:
A total of 1937 patients were enrolled in this study. Of these, 111 (5.7%) patients suffered from stroke during the median 3.5-year follow-up. Older age (odds ratio [OR], 1.03; 95% CI, 1.01-1.05; p = .009), history of hypertension (OR, 1.79; 95% CI, 1.18-2.73; p = .007), and history of stroke (OR, 2.00; 95% CI, 1.19-3.36; p = .008) were found to be independent predictors for stroke. Patients with and without stroke had similar risk of all-cause death (OR, 0.91; 95% CI, 0.59-1.41; p = .670). However, stroke was associated with higher odds ratio of heart failure (HF) hospitalization (OR, 2.77; 95% CI, 1.74-4.40; p < .001) and composite end point (OR, 1.61; 95% CI, 1.07-2.42; p = .021).
Conclusions:
Further research appears warranted to minimize the complication of stroke and improve long-term outcomes among patients with reduced EF who underwent such high risk revascularization procedural.
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