Incidence, Predictors, and Outcomes of Acute Ischemic Stroke Following Percutaneous Coronary Intervention
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Author + information
- Mohamad Alkhouli, MDa,b,∗ (mohamad.alkhouli{at}wvumedicine.org),
- Fahad Alqahtani, MDa,
- Abdulrahman Tarabishy, MDc,
- Gurpreet Sandhu, MDb and
- Charanjit S. Rihal, MDb
- aDivision of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
- bDepartment of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota
- cDivision of Neuroradiology, Department of Radiology, West Virginia University, Morgantown, West Virginia
- ↵∗Address for correspondence:
Dr. Mohamad Alkhouli, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, West Virginia 26505-8059.
Central Illustration
Abstract
Objectives The aim of this study was to assess temporal trends in the incidence of ischemic stroke among patients undergoing percutaneous coronary intervention (PCI), predictors of post-PCI ischemic stroke, and the impact of post-PCI ischemic stroke on in-hospital morbidity, mortality, length of stay, and cost.
Background Data on the incidence and outcomes of ischemic stroke in patients undergoing PCI in the contemporary era are limited.
Methods The National Inpatient Sample was used to identify patients who underwent PCI between January 1, 2003, and December 31, 2016. The incidence of post-PCI ischemic stroke was calculated, and its predictors were assessed. In-hospital outcomes of patients with and those without post-PCI stroke were also compared.
Results The adjusted incidence of post-PCI ischemic stroke increased during the study period from 0.6% to 0.96% following PCI for ST-segment elevation myocardial infarction, from 0.5% to 0.6% following PCI for non–ST-segment elevation myocardial infarction, and from 0.3% to 0.72% following PCI for unstable angina or stable ischemic disease (ptrend <0.001). Carotid disease, cardiogenic shock, atrial fibrillation, and older age were the strongest predictors of post-PCI ischemic stroke. Post-PCI stroke rates were lower at high-volume versus low- to intermediate-volume centers. Thrombolytics, cerebral angiography, and mechanical thrombectomy use increased over time but remained infrequent. After propensity score matching, in-hospital mortality was higher among patients with post-PCI stroke (23.5% vs. 11.0%, 9.5% vs. 2.8%, and 11.5% vs. 2.4% in the ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, and unstable angina or stable ischemic heart disease cohorts, respectively; p < 0.001). Post-PCI stroke was associated with a >2-fold increase in length of stay, a >3-fold increase in nonhome discharges, and a >60% increase in cost.
Conclusions The incidence of post-PCI ischemic stroke increased significantly over the past decade, partially because of the increasing complexity of patients undergoing PCI over time. Further studies are needed to systematically assess contributors to this worrisome trend and to identify effective strategies for its mitigation.
Footnotes
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 5, 2019.
- Revision received March 18, 2019.
- Accepted April 9, 2019.
- 2019 American College of Cardiology Foundation
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