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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Characteristics of cerebrovascular accidents after percutaneous coronary interventions

Srinivas Dukkipati, MD^*, William W. O'Neill, MD, FACC^*, Kishore J. Harjai, MD, FACC^*, William P. Sanders, MD, Datinder Deo, MD^*, Judith A. Boura, MS^*, Beth A. Bartholomew, MD^*, Michael W. Yerkey, MD^*, H. Mehrdad Sadeghi, MD^* and Joel K. Kahn, MD, FACC^*,*

^* Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan, USA

Manuscript received July 30, 2003; revised manuscript received October 30, 2003, accepted November 3, 2003.

^* Reprint requests and correspondence: Dr. Joel K. Kahn, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, Michigan 48073, USA.
jkahn{at}mhgpc.com

This study was presented in part as an abstract at the American College of Cardiology Scientific Sessions in Chicago, Illinois, in March 2003.

OBJECTIVES: We sought to identify the incidence, predictors, and clinical implications of cerebrovascular accidents (CVAs) after percutaneous coronary interventions (PCIs).

BACKGROUND: Cerebrovascular accidents after PCI, although rare, can be devastating. Limited information exists regarding the characterization of this complication.

METHODS: The study population comprised 20,679 patients who underwent PCI between September 1993 and April 2002. A CVA was defined as a composite of transient ischemic attack (TIA) and stroke. The characteristics of those who had a periprocedural CVA were compared with those who did not.

RESULTS: A CVA occurred in 92 patients (0.30% of procedures). Of these, TIA occurred in 13 patients (0.04%) and stroke in 79 patients (0.25%). On multivariate analysis, patients with this complication more frequently had diabetes mellitus (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1 to 3.0; p = 0.013), hypertension (OR 1.9, 95% CI 1.1 to 3.3; p = 0.033), previous CVA (OR 2.3, 95% CI 1.3 to 4.0; p = 0.0059), and creatinine clearance 40 ml/min (OR 3.1, 95% CI 1.8 to 5.2; p < 0.0001). They underwent urgent or emergent procedures (OR 2.7, 95% CI 1.3 to 5.5; p = 0.0092) with more thrombolytic (OR 4.7, 95% CI 2.3 to 9.7; p < 0.0001) and intravenous heparin (OR 1.9, 95% CI 1.1 to 3.4; p = 0.030) use before PCI, and they more often required emergent intra-aortic balloon pump placement (OR 2.2, 95% CI 1.1 to 4.3; p = 0.028). On multivariate analysis, CVA was independently associated with in-hospital death (OR 7.8, 95% CI 4.2 to 14.7; p < 0.0001), acute renal failure (OR 2.8, 95% CI 1.4 to 5.7; p = 0.0042), and new dialysis (OR 3.73, 95% CI 1.01 to 13.8; p = 0.049) after PCI.

CONCLUSIONS: Cerebrovascular accidents after PCI, although rare, are associated with high rates of in-hospital death and acute renal failure, often requiring dialysis.

Abbreviations and Acronyms   CI = confidence interval   CVA = cerebrovascular accident   IABP = intra-aortic balloon pump   MI = myocardial infarction   NQMI = non–Q-wave myocardial infarction   OR = odds ratio   PCI = percutaneous coronary intervention   TIA = transient ischemic attack

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