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

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

Research output: Contribution to journalArticle

25 Citations (Scopus)

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 2011

Fingerprint

Percutaneous Coronary Intervention
Incidence
Myocardial Infarction
Mortality
Transient Ischemic Attack
Hospital Mortality
Hospitalization
Retrospective Studies
Logistic Models
History
Regression Analysis
Demography

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

Cite this

Trends, predictors, and outcomes of cerebrovascular events related to percutaneous coronary intervention : A 16-year single-center experience. / Hoffman, Scott J.; Holmes, David; Rabinstein, Alejandro; Rihal, Charanjit; Gersh, Bernard J.; Lennon, Ryan J.; Bashir, Riyaz; Gulati, Rajiv.

In: JACC: Cardiovascular Interventions, Vol. 4, No. 4, 04.2011, p. 415-422.

Research output: Contribution to journalArticle

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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.",
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AU - Holmes, David

AU - Rabinstein, Alejandro

AU - Rihal, Charanjit

AU - Gersh, Bernard J.

AU - Lennon, Ryan J.

AU - Bashir, Riyaz

AU - Gulati, Rajiv

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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.

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KW - transient ischemic attack

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