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Post-PCI stroke more common in recent years
The incidence of ischemic stroke after PCI is low but has risen over the past decade, possibly due to an increase in patients with complex disease being treated with PCI, according to findings published in JACC Cardiovascular Interventions.
The researchers analyzed more than 8 million patients included in the National Inpatient Sample who underwent PCI between 2003 and 2016. They aimed to calculate the incidence of post-PCI stroke, identify the predictors of it and determine in-hospital outcomes of patients with post-PCI stroke compared with those who did not have it.
Adjusted incidence of post-PCI ischemic stroke rose from 0.6% in 2003 to 0.96% in 2016 among patients with STEMI, from 0.5% in 2003 to 0.6% in 2016 in patients with non-STEMI, and from 0.3% in 2003 to 0.72% in 2016 in patients with stable ischemic disease or unstable angina (P for trend for all < .001), Mohamad Alkhouli, MD, assistant program director of the cardiovascular disease fellowship program and medical director of the structural program at West Virginia University, and colleagues wrote.
According to the researchers, the strongest predictors of post-PCI stroke were carotid disease (adjusted OR = 3.72; 95% CI, 3.58-3.87), cardiogenic shock (aOR = 2.78; 95% CI, 2.67-2.88), atrial fibrillation (aOR = 1.8; 95% CI, 1.76-1.84) and older age (aOR per year = 1.018; 95% CI, 1.017-1.018).
Patients who had PCI at a center in the highest tertile of PCI volume were less likely to have a stroke after their procedure than those at a center in the lowest or middle tertile (P for both < .001), according to the researchers.
Use of thrombolytics, mechanical thrombectomy and cerebral angiography were uncommon but increased over time, Alkhouli and colleagues wrote.
In a propensity-score-matched analysis, in-hospital mortality was higher among those who had post-PCI stroke compared with those who did not (STEMI, 23.5% vs. 11%; non-STEMI, 9.5% vs. 2.8%; stable ischemic disease or unstable angina, 11.5% vs. 2.4%; P < .001 for all).
Post-PCI stroke was also associated with a more than twofold increase in length of stay, a more than threefold increase in discharge to somewhere other than home and a 60% increase in cost, according to the researchers.
“The incidence of post-PCI ischemic stroke is low but has increased significantly over the past decade, partially because of the increasing complexity of the patients treated and the intricacy of the PCI techniques themselves,” Alkhouli and colleagues wrote.
“The study calls for more innovative approaches for the prevention of post-
PCI stroke which has dismal prognosis,” Ahmad Abdel-Latif, MD, PhD, and Naoki Misumida, MD, both from the Gill Heart and Vascular Institute and division of cardiovascular medicine, University of Kentucky, wrote in a related editorial. “Additionally, studies examining the efficacy and safety of thrombolysis, and advanced catheter-based treatment approaches for acute post-PCI ischemic stroke are warranted.” – by Erik Swain
Disclosure: The study and editorial authors report no relevant financial disclosures.