TY - JOUR
T1 - Trends, predictors, and outcomes of cerebrovascular events related to percutaneous coronary intervention
T2 - A 16-year single-center experience
AU - Hoffman, Scott J.
AU - Holmes, David R.
AU - Rabinstein, Alejandro A.
AU - Rihal, Charanjit S.
AU - Gersh, Bernard J.
AU - Lennon, Ryan J.
AU - Bashir, Riyaz
AU - Gulati, Rajiv
N1 - Funding Information:
Dr. Gersh received research funding from Ortho-McNeil Janssen , Amorcyte Inc. , Merck Sharpe & Dohme , Abbott Laboratories , GE Healthcare , St. Jude Medical , Medispec , Merck & Co. , and Boston Scientific . All other authors have reported that they have no relationships to disclose. Mark Hlatky, MD, served as a Guest Editor for this paper.
PY - 2011/4
Y1 - 2011/4
N2 - 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.
AB - 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.
KW - cerebrovascular event
KW - coronary artery bypass graft
KW - intra-aortic balloon pump
KW - myocardial infarction
KW - outcomes
KW - percutaneous coronary intervention (PCI)
KW - stroke
KW - transient ischemic attack
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U2 - 10.1016/j.jcin.2010.11.010
DO - 10.1016/j.jcin.2010.11.010
M3 - Article
C2 - 21511221
AN - SCOPUS:79955099432
SN - 1936-8798
VL - 4
SP - 415
EP - 422
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 4
ER -