Prior ischemic stroke is not associated with worse clinical outcomes in patients undergoing percutaneous coronary intervention

Abstract

Prior ischemic stroke is not associated with worse clinical outcomes in patients undergoing percutaneous coronary intervention Abstract Purpose: Cerebrovascular accidents (CVAs) frequently coexist with coronary artery disease (CAD) and adversely a ect prognosis in patients with CAD; however, fewer studies have investigated the role of prior ischemic stroke on the outcomes of percutaneous coronary intervention (PCI). e aim of this study was to determine the safety and e ectiveness of PCI in patients with a prior ischemic stroke. 2005 (n=3893) at the Beijing Anzhen Hospital of Capital University of Medical Science, identi ed 295 PCI patients with a prior ischemic stroke (≥3 months) and 3598 patients without a prior stroke. To investigate whether prior history of an ischemic stroke was independently associated with increased risk of adverse PCI outcomes, prognostic parameters were analyzed using univariate analysis and Cox multivariate regression analysis. Propensity score analysis was then used to match the two subgroups of patients based on multiple factors known to impact cardiac outcome. Methods: A review of patients who underwent PCI between June 2003 and SeptemberResults: Patients with a prior ischemic stroke had more frequent high-risk baseline characteristics (diabetes, hypertension, hyperlipidemia and prior myocardial infarction). No signi cant di erences were found in the major adverse cardiac and cerebrovascular event (MACCEs) rates between the two groups (1.7% in the stroke group vs. 1.4% in the nonstroke group; p=0.06). Diabetes mellitus, triple vessel CAD, number of diseased vessels, chronic total occlusion and previous myocardial infarction were independent predictors of MACCE in patients with prior stroke undergoing PCI.Conclusions: is study demonstrates that, in daily clinical practice, PCI can be provided safely and with good results to patients with a prior ischemic stroke (≥3 months).

Outcomes After Percutaneous Coronary Intervention in Patients With a History of Cerebrovascular Disease

“…9,21 Whereas, Zhang et al and Sasao et al found no significant differences in rates of post-PCI stroke in patients with and without a history of TIA or stroke. 7,8 Our findings underscore the importance of appropriately counseling patients with a history of TIA or stroke on the risks of post-PCI in-hospital stroke. An open conversation of patient-specific risks and benefits of PCI is integral to the process of shared decision-making.…”

“…Among the few studies evaluating the relationship between a history of TIA or stroke and PCI outcomes, the majority have been limited by single-center study designs, 7–9 or an evaluation of in-hospital outcomes only. 7,9 Given the recent evidence from RCTs suggesting that patients with a history of stroke are at an increased risk of adverse events, 3,4 along with the relatively high prevalence of patients with a history of TIA or stroke undergoing PCI, it is important to understand whether such patients are at an increased risk of in-hospital and post-discharge outcomes after PCI in real-world practice. Therefore, we sought to examine this relationship using a large, contemporary, clinical registry of all PCIs performed at non-federal hospitals in the state of Michigan.…”

Impact of Preexisting Vascular Disease on the Outcome of Patients With Acute Coronary Syndrome: Insights From the Comparison of Bioactive Stent to the Everolimus-Eluting Stent in Acute Coronary Syndrome Trial

“…8 The results of patients with a history of prior cerebrovascular stroke undergoing PCI have been controversial. 6,7…”

“…8 The results of patients with a history of prior cerebrovascular stroke undergoing PCI have been controversial. 6,7 To date, no reports addressed the outcome of patients with a history of atherosclerotic vascular disease (that includes collectively coronary, cerebrovascular, and peripheral arterial disease) who present with ACS and undergo early PCI in the contemporary era of drug-eluting stents, advanced angioplasty techniques, and aggressive antithrombotic therapy. The current report demonstrated a worse long-term clinical outcome in such patient category; however, ongoing with evidence from the prior reports, a history of preexisting vascular disease was not an independent predictor of long-term MACE in multivariable analysis.…”

“…[1][2][3][4][5][6] However, 2 recent studies demonstrated a neutral impact of prior cerebrovascular stroke and prior PCI on the clinical outcome of elective and primary PCI, respectively. 7,8 Yet, limited data exist on the overall prevalence of preexisting vascular disease (coronary, cerebrovascular, and peripheral) in patients presenting with ACS and on the long-term clinical outcome of PCI in this particularly high-risk patient subset.…”