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(Circulation. 2002;106:86.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Stroke Complicating Percutaneous Coronary Interventions

Incidence, Predictors, and Prognostic Implications

Shmuel Fuchs, MD; Eugenio Stabile, MD; Timothy D. Kinnaird, MD; Gary S. Mintz, MD; Luis Gruberg, MD; Daniel A. Canos, MPH; Ellen E. Pinnow, MS; Ran Kornowski, MD; William O. Suddath, MD; Lowell F. Satler, MD; Augusto D. Pichard, MD; Kenneth M. Kent, MD; Neil J. Weissman, MD

From the Cardiovascular Research Institute and the Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC; Cardiovascular Research Foundation (G.S.M.), New York, NY; and Rabin Medical Center (R.K.), Petach-Tikva, Israel.

Correspondence to Shmuel Fuchs, MD, Cardiovascular Research Institute and the Cardiac Catheterization Laboratories, Washington Hospital Center, 110 Irving St NW, Suite 4B-1, Washington, DC 20010. E-mail shmuel.fuchs{at}medstar.net

Background— Stroke associated with percutaneous coronary intervention (PCI) is an infrequent although devastating complication. We investigated the incidence, predictors, and prognostic impact of periprocedural stroke in unselected patients undergoing PCI.

Methods and Results— A total of 9662 patients who underwent 12 407 PCIs between January 1990 and July 1999 were retrospectively studied. Stroke was diagnosed in 43 patients (0.38% of procedures). Patients with stroke were older (72±11 versus 64±11 years, P<0.001), had lower left ventricular ejection fraction (42±12 versus 46±13%, P=0.04) and more diabetes (39.5% versus 27.2%, P=0.07), and experienced a higher rate of intraprocedural complications necessitating emergency use of intra-aortic balloon pump (IABP) (23.3% versus 3.3%, P<0.001). In-hospital mortality (37.2% versus 1.1%, P<0.001) and 1-year mortality (56.1% versus 6.5%, P<0.001) were higher in patients with stroke. Compared with hemorrhagic stroke, patients with ischemic stroke had higher rate of in-hospital major adverse cardiac events (57.1% versus 25%, P=0.037). Multivariate logistic regression analysis identified emergency use of IABP as the strongest predictors for stroke (OR=9.6, CI 3.9 to 23.9, P<0.001), followed by prophylactic use of IABP (OR=5.1), age >80 years (OR=3.2, compared with age <50 years), and vein graft intervention (OR=2.7).

Conclusions— Stroke associated with contemporary PCI is associated with substantial increased mortality. Elderly patients who experience intraprocedural complications necessitating the use of IABP are at particularly high risk.

Key Words: stroke • angioplasty • prognosis

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