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TIA, stroke linked to higher CAD risk after PCI
Patients with a history of transient ischemic attack or stroke have an elevated risk for CAD after PCI, due to shared risk factors between CAD and cerebrovascular disease, according to an observational analysis published in Circulation: Cardiovascular Interventions.
“Among the few studies evaluating the relationship between a history of TIA or stroke and PCI outcomes, the majority have been limited by single-center study designs or an evaluation of in-hospital outcomes only,” Chris Song, MD, from the division of cardiovascular medicine and department of internal medicine at University of Michigan Medical School, and colleagues wrote in the study background. “Given the recent evidence from randomized controlled trials suggesting that patients with a history of stroke are at an increased risk of adverse events, along with the relatively high prevalence of patients with a history of TIA or stroke undergoing PCI, it is important to understand whether such patients are at an increased risk of in-hospital and postdischarge outcomes after PCI in real-world practice.”
To explore the relationship between TIA or stroke and PCI, the researchers conducted a retrospective observational analysis of patients who underwent PCI between 2013 and 2016 at 47 Michigan hospitals and identified those with a history of TIA or stroke.
Song and colleagues compared in-hospital outcomes for patients with vs. without a history of TIA/stroke and adjusted for differences in baseline characteristics using propensity-score matching.
Rates of 90-day readmission and long-term mortality in a subset of patients were also compared by the researchers.
It was found that 10,915 of the 98,730 patients who underwent PCI had a history of TIA/stroke.
After propensity-score matching (n = 10,618 in each group), TIA/stroke was linked to increased risk for in-hospital stroke after PCI (adjusted OR = 2.04; 95% CI, 1.41-2.96).
The researchers found no differences between the groups in other in-hospital outcomes.
In a subset analysis of patients with postdischarge data, a history of TIA/stroke was linked to increased risk for 90-day readmission (aOR = 1.22; 95% CI, 1.09-1.38) and long-term mortality (HR = 1.23; 95% CI, 1.07-1.43).
According to the researchers, the study provides real-world evidence that history of TIA or stroke is associated with adverse outcomes after PCI.
“Although the absolute increase in the risk of post-PCI stroke is small and may not dissuade practitioners from recommending PCI, given the possibly devastating consequences of post-PCI stroke, we think that patients with a history of TIA or stroke should be counseled on this increased risk in the current era of shared decision-making,” Song and colleagues wrote. “In addition, further research is needed to understand the mechanisms responsible for the increased risks of post-PCI stroke and postdischarge adverse outcomes in this high-risk subgroup of patients so that effective strategies can be developed to reduce these risks.” – by Dave Quaile
Disclosures: Song reports no relevant financial disclosures. Another author reports receiving research funding from Blue Cross Blue Shield of Michigan and consultant fees from Osprey Medical.