Abstract 2176: Hemorrhagic Stroke After Percutaneous Coronary Interventions (PCI) with Coronary Stents In Patients with Acute Coronary Syndrome (ACS): Results From The Registry of Japan Acute Coronary Syndrome Study (JACSS)
Background A recent meta-analysis has given warning that facilitated PCI with thrombolytic-based regimens for STEMI had no benefit over primary PCI because of higher prevalence in short-term major bleeding complications in those patients. The analysis includes 6 trials done between 1992 and 2006, therefore it does not really reflect the current trend in PCI for ACS, i.e. frequent usage of coronary stents and consequent increasing in antiplatelet agents. Until now, it is not well elucidated that the frequency of intracranial hemorrhage, which has the worst prognosis of bleeding complications in the real clinical settings of ACS.
Methods and Results To examine the clinical characteristics of intracranial bleeding in the era of primary PCI with coronary stents, consecutive 3,130 patients with ACS who were admitted to our institutes within 48 hours after symptom onset from January, 2001 to December, 2002 were analyzed. Time from symptom onset to hospital admission was 6.5±8.8 hours. PCI was done in 69% of the patients as a reperfusion therapy in the acute phase and coronary stents were used in 81% of the PCI cases. Tissue-type plasminogen activator was administered alone in 5% and with PCI in 12% of the study patients. Hemorrhagic stroke occurred in 0.26% (8 cases) of all the study patients. All the 8 cases underwent stents implantation and 3 of them were concomitantly administered thrombolytic agents (2 cases with facilitated PCI and 1 with intracoronary injection after primary PCI). In stenting cases, thrombolytic agents were more frequently used in patients with hemorrhagic stroke than in those without (38% vs. 16%, p=0.10). There were no hemorrhagic stroke cases in patients with solely administered thrombolytic agents. Multiple regression analysis revealed that use of more than 3 antithrombotic agents was a significant predictor of hemorrhagic stroke.
Conclusions Usage of multiple antithrombotic agents with thrombolytic therapy after coronary stents was a significant predictor of hemorrhagic stroke in acute myocardial infarction. Thrombolytic agent administered alone was not necessarily associated with this severe hemorrhagic complication.