Temporal Trends in Percutaneous Coronary Intervention–Associated Acute Cerebrovascular Accident (from the 1998 to 2008 Nationwide Inpatient Sample Database)

Abstract

Acute cerebrovascular accident (CVA) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and coronary artery disease (CAD) is associated with high morbidity and mortality. Nationwide Inpatient Sample from 1998 to 2008 was utilized to identify 1,552,602 PCIs performed for ACS and CAD. We assessed temporal trends in the incidence, predictors and prognostic impact of CVA in a broad range of patients undergoing PCI. The overall incidence of CVA was 0.56% (95% confidence interval (CI), 0.55%–0.57%). The incidence of CVA remained unchanged over the study period (adjusted p for trend = 0.2271). The overall mortality in the CVA group was 10.76% (95% CI, 10.1%–11.4%). The adjusted odds ratio (OR) of CVA for in-hospital mortality was 7.74 (95% CI, 7.00–8.57; p<0.0001); this remained high but decreased over the study period (adjusted p for trend <0.0001). Independent predictors of CVA included older age (OR, 1.03, 95% CI, 1.02–1.03; p<0.0001), disorder of lipid metabolism (OR, 1.31, 95% CI, 1.24–1.38; p<0.001), history of tobacco use (OR, 1.21, 95% CI, 1.10–1.34; p=0.0002), coronary atherosclerosis (OR 1.56, 95% CI, 1.43–1.71; p<0.0001), and IABP use (OR 1.39, 95% CI, 1.09–1.77; p=0.0073). A nomogram for predicting the probability of CVA achieved a concordance index of 0.73 and was well calibrated. In conclusion, the incidence of CVA associated with PCI has remained unchanged from 1998–2008 in face of improved equipment, techniques and adjunctive pharmacology. The risk of CVA associated in-hospital mortality is high; however, this risk has declined over the study period.

Transient lateral rectus palsy associated with acute coronary syndrome treated with percutaneous coronary intervention: a case report

“…Since the incidence rate of acute stroke after PCI is 0.56%, it can be suggested that our patient experienced an ischemic event of unilateral abducens. This can happen due to microembolism during PCI resulting in left lateral rectus palsy [ 11 ]. Moreover, the proposed mechanisms of it include the formation of blood clots within the catheter and arterial wall along with their displacement.…”

Complicaciones cerebrovasculares luego de angiografía coronaria en contexto de infarto agudo de miocardio. Estudio de cohorte

“…El ACV y el AIT son complicaciones temibles, con una incidencia reportada entre 0,07% y 1% (4)(5)(6)(7)(8)(9)(10)(11)(12) . La ICP incrementa 17 veces el riesgo de presentarlas dentro de las primeras 48 horas del procedimiento (13) .…”

“…Entre las primeras se destacan: edad avanzada, sexo femenino, diabetes mellitus (DM), hipertensión arterial (HTA), enfermedad renal crónica (ERC) o enfermedad cerebrovascular previa, y fracción de eyección del ventrículo izquierdo (FEVI) disminuida. En cuanto a las características del procedimiento, se asocian con mayor riesgo los procedimientos más largos, con mayor volumen de contraste, utilización de catéteres más rígidos y de mayor calibre, procedimientos de emergencia, trombectomía, ATC sobre puentes venosos o sobre lesiones más complejas y uso de balón de contrapulsación intraaórtico (BCIA) (2,(4)(5)(6)(7)10,11,(14)(15)(16)(17)(18) .…”

Impact of Cerebrovascular Events Older Than One Year on Ischemic and Bleeding Outcomes With Cangrelor in Percutaneous Coronary Intervention

“…6,7 Risk factors for periprocedural stroke include known cerebrovascular disease, older age, coronary atherosclerosis, and intra-aortic balloon pump use. [1][2][3] A history of prior cerebrovascular event also increases the risk of intracerebral hemorrhage related to PCI. 8 Utilization of platelet aggregation antagonists in addition to aspirin at the time of PCI has significantly reduced periprocedural ischemic events and has been adopted as the standard of care.…”

“…[1][2][3] The majority of periprocedural strokes are ischemic in nature, with an embolic pattern and often involving the middle cerebral artery. 4,5 Stroke during PCI is associated with a substantial increase in both inhospital and 30-day mortality.…”