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Published on: October 15, 2021
Intracranial Hemorrhage in Hospitalized Patients Following Percutaneous Coronary Intervention: A Large Cohort
Cheng Yang1, Yong-Gang Sui1, Bin-Cheng Wang1
1Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Intracranial hemorrhage (ICH) after percutaneous coronary intervention (PCI) is rare (0.015%) but deadly. Early symptoms like consciousness disturbance and large hematomas predict poor outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Intracranial hemorrhage (ICH) is a rare but severe complication following percutaneous coronary intervention (PCI).
- While ICH after PCI is known, detailed clinical characteristics and outcomes of CT-confirmed, symptomatic cases are not fully understood.
Purpose of the Study:
- To characterize the clinical landscape, including timing, features, and outcomes, of CT-confirmed, symptomatic intracranial hemorrhage (ICH) in patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective analysis of 121,066 patients undergoing PCI between 2013 and 2022.
- Identified 18 patients with CT-defined, symptomatic ICH during hospitalization post-PCI.
- Analyzed timing, clinical and imaging features, and 90-day mortality.
Main Results:
- The incidence of symptomatic ICH post-PCI was 0.015%.
- Over half of ICH cases occurred within 12 hours of PCI, with consciousness disturbance being the most common initial symptom.
- High 90-day mortality (72.2%) was associated with consciousness disturbance, large hematoma volume (≥30 cm³), and infratentorial origin.
Conclusions:
- Symptomatic intracranial hemorrhage following PCI is a rare event with a significant short-term mortality risk.
- Clinical factors such as altered consciousness, large hematoma volume, and infratentorial location are associated with increased mortality in this patient population.
Background:
There are several reports on the prevalence and characteristics of intracranial hemorrhage (ICH) following percutaneous coronary intervention (PCI), which is a rare but severe complication with high mortality. However, the clinical landscapes of computed tomography (CT)-confirmed, symptomatic ICH in hospitalized patients are not fully characterized.
Methods:
Among 121,066 patients receiving PCI treatment in the Fu Wai Hospital between 2013 and 2022, there were 18 CT-defined, symptomatic patients with ICH occurring during post-PCI hospitalization. Symptomatic ICH was defined as clinical suspicion of hemorrhage and/or new focal neurological signs. We analyzed ICH timing, clinical and imaging features, and subsequent outcomes.
Results:
Overall, in this retrospective analysis, the incidence of CT-defined, symptomatic ICH was 0.015% (18/121,066). More than half of the cases (55.6%) occurred within the first 12 h following PCI. The most common initial manifestation of ICH patients was disturbance of consciousness. Thirteen patients (72.2%) had a hematoma volume ≥ 30 cm3. Additionally, the ICH was observed in the cerebral lobe (66.7%), cerebellum (22.2%), and the basal ganglia and thalamus (11.1%). The 90-day mortality of ICH patients undergoing PCI was very high (72.2%). Consciousness disturbance (p = 0.036), intracerebral hemorrhage volume > 30 mm3 (p = 0.001), and intracerebral hemorrhage originating from the infratentorial origin (p = 0.044) were significantly higher in patients who died.
Conclusions:
Symptomatic ICH events occur with a rate of around 0.015%, with significantly higher short-term mortality risk in our cohort receiving PCI, which has not yet been demonstrated in other cohorts.
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