Incidence, predictors and impact of stroke on mortality after percutaneous coronary intervention

  • Chandiramani R & al.
  • Catheter Cardiovasc Interv
  • 14 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Stroke occurrence within 1 year was common in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).
  • Post-PCI stroke occurrence had a significantly greater effect on subsequent 30-day mortality compared with myocardial infarction (MI) and bleeding, but the association was no longer significant after 30 days of stroke occurrence.

Why this matters

  • The findings highlight that the implementation of measures to prevent the occurrence of stroke in patients with ACS who underwent PCI may improve prognosis.

Study design

  • 19,914 patients with ACS who underwent PCI were included using the data from the PROMETHEUS study.
  • Primary outcome: cumulative stroke incidence and all-cause mortality at 30 days and 1 year.
  • Other outcomes: risk for MI and bleeding.
  • Funding: Daiichi Sankyo and Eli Lilly and Company.

Key results

  • Of 19,914 patients with ACS, 244 reported strokes within 1-year follow-up with a cumulative incidence of 1.5% (95% CI, 1.3-1.6%).
  • Previous cardiovascular disease was the independent predictor of stroke (HR, 5.37; P<.0001 followed by st-elevation mi p non-st-elevation hypertension smoking female sex and age>
  • The risk for all-cause mortality was significantly higher in patients with stroke vs those without (adjusted HR [aHR], 4.84; P<.0001>
  • Patients with stroke were at increased risk for mortality in the subsequent 30 days (aHR, 17.7; P<.0001 vs beyond days p=".58).</li">

Limitations

  • Retrospective design.
  • Risk of unmeasured confounding.

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