Abstract 15298: Most Strokes Occur More Than 48 Hours Following Primary Percutaneous Coronary Intervention in STEMI: the Stroke Experience in APEX-AMI Trial
Background- Stroke is a devastating complication when it occurs in the setting of acute myocardial infarction (AMI). Little is known about stroke timing, characteristics, and associated clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) in the contemporary era.
Methods- We studied 5740 patients with STEMI treated with primary PCI enrolled in the APEX-AMI trial. We analyzed stroke incidence, type, timing, and relation to 90-day clinical outcomes. Cox proportional hazards modeling was used to adjust for baseline characteristics.
Results- Stroke occurred in 77 of 5740 (1.3%) of patients treated with primary PCI. Patients with stroke were older (median 72 years vs 61 without stroke), more likely to have hypertension and prior cerebrovascular disease, and more likely to present with heart failure. When type of stroke was examined it proved to be 36% (28) ischemic, 12% (9) hemorrhagic, and 52% (40) of uncertain type. The median (25th,75th) time of stroke occurrence was 4 (1, 18) days (Figure). Stroke occurred within 24 hours of randomization in only 26% of patients and within 48 hours in 42% of patients. Stroke when fitted as a time dependent covariate was associated with an increased risk of 30-day death [adjusted hazard ratio (HR) 4.94; 95% confidence interval (CI) 3.03, 8.05; P <0.001] and 90-day death [HR 4.98; 95% CI 3.05, 8.11; P<0.001].
Conclusions- Stroke complicated 1.3% of primary PCIs performed for STEMI with 58% occurring after 48 hours following randomization. The later occurrence suggests that the majority of the risk of stroke may not be procedure-related and calls for more study of prevention of stroke following primary PCI.
- Percutaneous coronary intervention
- Myocardial infarction, STEMI
- Acute coronary syndromes
- © 2011 by American Heart Association, Inc.