Trends, predictors, and outcomes of cerebrovascular events related to percutaneous coronary intervention: A 16-year single-center experience

Scott J. Hoffman, David R. Holmes, Alejandro A. Rabinstein, Charanjit S. Rihal, Bernard J. Gersh, Ryan J. Lennon, Riyaz Bashir, Rajiv Gulati

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25 Scopus citations

Abstract

Objectives: We sought to determine trends, predictors, in-hospital and long-term outcomes of cerebrovascular events (CVE) related to percutaneous coronary intervention (PCI) over a 16-year period. Background: Despite a temporal increase in patient risk profile and procedural complexity, rates of PCI-related mortality and myocardial infarction have decreased. Temporal trends, characterization, and outcomes after PCI-related CVE in the contemporary era remain unknown. Methods: We performed a retrospective study of 24,126 PCI hospitalizations in 19,165 unique patients, between January 1, 1994, and December 31, 2009, and compared those who suffered an in-hospital PCI-CVE with the remaining control population who did not. Results: The incidence of CVE was 0.37% (n = 89), of which 22% were transient ischemic attacks. Temporal analysis showed no significant trend in incidence over 16 years (p = 0.47). Multiple clinical and angiographic predictors of PCI-CVE were identified. Multivariate logistic regression analyses revealed age, female sex, myocardial infarction within 7 days before PCI, and history of prior CVE as independent predictors of PCI-CVE, with a 19-fold increase in incidence in patients over 80 with a prior CVE history. In-hospital mortality was 19% after PCI-CVE versus 2% in controls (p < 0.001). Those who survived PCI-CVE exhibited a markedly higher risk of mortality over the subsequent 10 years (p < 0.001). Conclusions: The incidence of PCI-related CVE has remained steady over a 16-year period, despite an increase in the baseline risk profile. Age and prior history of CVE were the strongest independent demographic predictors. PCI-CVE had a markedly adverse impact on early and late outcomes.

Original languageEnglish (US)
Pages (from-to)415-422
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume4
Issue number4
DOIs
StatePublished - Apr 1 2011

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Keywords

  • cerebrovascular event
  • coronary artery bypass graft
  • intra-aortic balloon pump
  • myocardial infarction
  • outcomes
  • percutaneous coronary intervention (PCI)
  • stroke
  • transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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