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 |
|
This article has been cited by other articles:
|
|
|
|
 
A. J. Kreis, T. Nguyen, S. Rogers, J. J. Wang, C. A. Harper, D. J. Clark, H.M. O. Farouque, and T. Y. Wong
Acute Retinal Arteriolar Emboli After Cardiac Catheterization
Stroke,
November 1, 2008;
39(11):
3086 - 3087.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Hamon, J.-C. Baron, F. Viader, and M. Hamon
Periprocedural Stroke and Cardiac Catheterization
Circulation,
August 5, 2008;
118(6):
678 - 683.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Khatri, S. E. Kasner, and D. Kolansky
Reply
J. Am. Coll. Cardiol.,
July 22, 2008;
52(4):
317 - 318.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Khatri and S. E. Kasner
Ischemic strokes after cardiac catheterization: opportune thrombolysis candidates?
Arch Neurol,
June 1, 2006;
63(6):
817 - 821.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
