Abstract 4298: Trends, Predictors, and Outcomes of Stroke Related to Percutaneous Coronary Intervention: A Fifteen Year Single Center Experience
Aims We sought to determine temporal trends, predictors, in-hospital and long-term outcomes of stroke related to percutaneous coronary intervention (PCI) over a 15 year period.
Methods and results We performed a retrospective study of 21,502 PCI hospitalizations in 17,249 unique patients between 1994 and 2008. We identified those who suffered a PCI related cerebrovascular accident (CVA), defined as stroke or transient ischemic attack (TIA), and compared outcomes with the remaining control population. The overall incidence of CVA was 0.39% (n=84), of which 23% were TIAs. Type of CVA was hemorrhagic in 6%, ischemic in 88% and unknown in 6%. Temporal analysis showed no significant trend in incidence over 15 years (p=0.82). Patients with CVA were more likely to be older (age 74.3±10.4 vs 66.3±12.0, p<0.001), female (52.4% vs 29.3%, p<0.001), have moderate-to-severe renal disease (8.3% vs 3.7%, p=0.033), a past history of CVA (31.0% vs 11.3%, p<0.001), experience pre-procedural cardiogenic shock (10.7% vs 3.8%, p=0.002), or have suffered a myocardial infarction (MI) within 7 days prior to PCI (58.3% vs 31.9%, p<0.001). Angiographic predictors of CVA included the number of diseased coronary arteries, the presence of intracoronary thrombus (each p<0.001), increased number of segments or vessels treated (p<0.001 and p=0.033), and the need for emergent PCI (p<0.001). Multivariate logistic regression analyses identified age, female gender, MI within 7 days prior to PCI, history of previous CVA, intracoronary thrombus, and multivessel intervention as independent predictors of CVA after PCI. CVA was associated with a dramatically increased rate of in-hospital mortality compared with controls (20.2% vs 1.8%; p<0.001). Moreover, in survivors of PCI related CVA, Kaplan-Meier analysis indicated a markedly higher risk of mortality over the subsequent 10 years (p<0.001).
Conclusion The incidence of CVA related to PCI has remained steady over this 15 year period. Age, female gender and history of stroke are significant independent demographic predictors. Both in-hospital and long-term outcomes are markedly worse in sufferers of PCI-related CVA compared with controls.