Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication

Phyo Kyaw Myint; Chun Shing Kwok; Christine Roffe; Evangelos Kontopantelis; Azfar Zaman; Colin Berry; Peter F. Ludman; Mark A. de Belder; Mamas A. Mamas; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research

doi:10.1161/STROKEAHA.116.012700

Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication

Phyo Kyaw Myint, Chun Shing Kwok, Christine Roffe, Evangelos Kontopantelis, Azfar Zaman, Colin Berry, Peter F. Ludman, Mark A. de Belder, Mamas A. Mamas, British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research

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Abstract

BACKGROUND AND PURPOSE: Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.

METHODS: The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).

RESULTS: A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively.

CONCLUSIONS: Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.

Original language	English
Pages (from-to)	1500-1507
Number of pages	8
Journal	Stroke
Volume	47
Issue number	6
Early online date	10 May 2016
DOIs	https://doi.org/10.1161/STROKEAHA.116.012700
Publication status	Published - Jun 2016

Bibliographical note

Acknowledgments

P.K.M. and M.A.M. conceived the study. P.K.M. formulated study design. C.S.K. and E.K. analyzed the data. P.K.M. and M.A.M. drafted the manuscript. All authors contributed in interpretation of results and in making an important intellectual contribution to the manuscript. M.A.M. is the guarantor.

Sources of Funding

The work was supported by a grant from the North Staffs Heart Committee. MRC Health eResearch Centre Grant MR/K006665/1 supported the time and facilities of E.K.

Keywords

elective percutaneous coronary intervention
mortality
nonelective percutaneous coronary intervention
prognosis
risk factor
stroke

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Phyo Myint, Clinical Chair in Medicine of Old Age
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair in Old Age Medicine (Clinical)
- Institute of Applied Health Sciences
Person: Clinical Academic

Cite this

Myint, P. K., Kwok, C. S., Roffe, C., Kontopantelis, E., Zaman, A., Berry, C., Ludman, P. F., de Belder, M. A., Mamas, M. A., & British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research (2016). Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication. Stroke, 47(6), 1500-1507. https://doi.org/10.1161/STROKEAHA.116.012700

Myint, PK, Kwok, CS, Roffe, C, Kontopantelis, E, Zaman, A, Berry, C, Ludman, PF, de Belder, MA, Mamas, MA & British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research 2016, 'Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication', Stroke, vol. 47, no. 6, pp. 1500-1507. https://doi.org/10.1161/STROKEAHA.116.012700

@article{92bdefdf690c400a8d919e1dd47fe736,

title = "Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication",

abstract = "BACKGROUND AND PURPOSE: Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.METHODS: The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).RESULTS: A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively.CONCLUSIONS: Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.",

keywords = "elective percutaneous coronary intervention, mortality, nonelective percutaneous coronary intervention, prognosis, risk factor, stroke",

author = "Myint, {Phyo Kyaw} and Kwok, {Chun Shing} and Christine Roffe and Evangelos Kontopantelis and Azfar Zaman and Colin Berry and Ludman, {Peter F.} and {de Belder}, {Mark A.} and Mamas, {Mamas A.} and {British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research}",

note = "Acknowledgments P.K.M. and M.A.M. conceived the study. P.K.M. formulated study design. C.S.K. and E.K. analyzed the data. P.K.M. and M.A.M. drafted the manuscript. All authors contributed in interpretation of results and in making an important intellectual contribution to the manuscript. M.A.M. is the guarantor. Sources of Funding The work was supported by a grant from the North Staffs Heart Committee. MRC Health eResearch Centre Grant MR/K006665/1 supported the time and facilities of E.K.",

year = "2016",

month = jun,

doi = "10.1161/STROKEAHA.116.012700",

language = "English",

volume = "47",

pages = "1500--1507",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "6",

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TY - JOUR

T1 - Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication

AU - Myint, Phyo Kyaw

AU - Kwok, Chun Shing

AU - Roffe, Christine

AU - Kontopantelis, Evangelos

AU - Zaman, Azfar

AU - Berry, Colin

AU - Ludman, Peter F.

AU - de Belder, Mark A.

AU - Mamas, Mamas A.

AU - British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research

N1 - Acknowledgments P.K.M. and M.A.M. conceived the study. P.K.M. formulated study design. C.S.K. and E.K. analyzed the data. P.K.M. and M.A.M. drafted the manuscript. All authors contributed in interpretation of results and in making an important intellectual contribution to the manuscript. M.A.M. is the guarantor. Sources of Funding The work was supported by a grant from the North Staffs Heart Committee. MRC Health eResearch Centre Grant MR/K006665/1 supported the time and facilities of E.K.

PY - 2016/6

Y1 - 2016/6

N2 - BACKGROUND AND PURPOSE: Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.METHODS: The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).RESULTS: A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively.CONCLUSIONS: Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.

AB - BACKGROUND AND PURPOSE: Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.METHODS: The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).RESULTS: A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively.CONCLUSIONS: Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.

KW - elective percutaneous coronary intervention

KW - mortality

KW - nonelective percutaneous coronary intervention

KW - prognosis

KW - risk factor

KW - stroke

U2 - 10.1161/STROKEAHA.116.012700

DO - 10.1161/STROKEAHA.116.012700

M3 - Article

C2 - 27165953

SN - 0039-2499

VL - 47

SP - 1500

EP - 1507

JO - Stroke

JF - Stroke

IS - 6

ER -

Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication

Abstract

Bibliographical note

Keywords

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Phyo Myint, Clinical Chair in Medicine of Old Age

Cite this