Rate of cerebrovascular accident, TIA low after PCI

The incidence of cerebrovascular accident and transient ischemic attack after PCI is low, and rates remained stable during the past 12 years, researchers reported in a new study.

However, post-PCI cerebrovascular accident (CVA) and TIA are associated with a significant increase in in-hospital mortality and 1-year mortality.

Researchers published results of an observational, retrospective, single-center analysis that included 25,626 consecutive patients who underwent PCI at the MedStar Washington Hospital Center in Washington, D.C., from 2002 to June 2015. Neurologic outcomes were available for all patients included. The mean age of the patients was 65 years (65% male; 28.6% black).

The primary endpoint was frequency of CVA or TIA. Secondary endpoints included in-hospital and 1-year all-cause mortality.

Post-PCI neurologic events occurred in 0.43% of patients during the study period. Of those, 0.34% were CVA and 0.09% were TIA. The researchers calculated an annual rate of post-PCI neurologic events of 0.42%.

Neurologic events were more frequent in black patients (43.6% vs. 28.6%; P < .001), those with a prior history of CVA (24.5% vs. 7.8%; P < .001), those with chronic renal insufficiency (26.6% vs. 15.1%; P < .001) and those with insulin-dependent diabetes (19.1% vs. 12.4%; P = .03) compared with patients who did not experience neurologic events.

Patients who developed neurologic events after PCI also had a higher prevalence of acute MI (56% vs. 30.4%; P < .001) and cardiogenic shock (20.2% vs. 3%; P < .001) compared with patients who did not experience neurologic events.

Patients with neurologic events had higher in-hospital mortality (20.7% vs. 1.5%; P < .001) and 1-year mortality (45% vs. 7.3%; P < .001) compared with patients who did not experience neurologic events. However, compared with CVA, patients with TIA had a lower rate of in-hospital mortality (4.2% vs. 25.3%; P < .001) and 1-year mortality (7.7% vs. 56.3%; P < .001).

In addition, the findings revealed a trend toward longer procedure time (mean, 68.8 minutes vs. 61.5 minutes; P = .05) and median hospital stay (9.5 days vs. 2.5 days; P < .001) in patients with CVA or TIA compared with patients who did not experience neurologic events. Intra-aortic balloon pump use also was increased in patients with neurologic events (26.4% vs. 5%; P ≤ .001).

“The incidence of neurologic events in our study is reasonably consistent with previous publications that reported stroke incidence post-PCI in the United States and in Europe,” the researchers wrote.

Multivariable adjustment revealed a strong association between neurologic events and the following:

• use of an intra-aortic balloon pump (OR = 4.9; 95% CI, 2.7-8.8);
• previous CVA (OR = 2.4; 95% CI, 1.4-4.4); and
• black race (OR = 2.4; 95% CI, 1.5-3.9).

The researchers reported a borderline association on multivariable adjustment between neurologic events and use of a thrombus-extraction device (OR = 1.7; 95% CI, 0.9-3.2).

“Although post-PCI CVA and TIA are rare, the high rate of in-hospital adverse outcomes in such patients emphasizes the need for effective treatment of stroke after PCI,” the researchers concluded. – by Jennifer Byrne

Disclosure: The researchers report no relevant financial disclosures.