Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007-12

Chun Shing Kwok, Evangelos Kontopantelis, Phyo K Myint, Azfar Zaman, Colin Berry, Bernard Keavney, Jim Nolan, Peter F Ludman, Mark A de Belder, Iain Buchan, Mamas A Mamas, British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research

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Abstract

AIMS: This study aims to evaluate temporal changes in stroke complications and their association with mortality and MACE outcomes in a national cohort of patients undergoing percutaneous coronary interventions (PCIs) in England and Wales.

METHODS AND RESULTS: A total of 426 046 patients who underwent PCI in England and Wales between 2007 and 2012 in the British Cardiovascular Intervention Society (BCIS) database were analysed. Statistical analyses were performed evaluating the rates of stroke complications according to the year of PCI and multiple logistic regressions were used to evaluate the odds of 30-day mortality and in-hospital major adverse cardiovascular events (MACE; a composite of in-hospital mortality, myocardial infarction or re-infarction, and revascularization) with stroke complications. Four hundred and thirty-six patients (0.1%) sustained an ischaemic stroke/TIA complication and 107 patients (0.03%) sustained a haemorrhagic stroke complication. Ischaemic stroke/TIA complications increased non-linearly from 0.67 (95% CI 0.47-0.87) to 1.14 (0.94-1.34) per 1000 patients between 2007 and 2012 (P = 0.006), whilst haemorrhagic stroke rates decreased non-linearly from 0.29 (0.19-0.39) to 0.15 (0.05-0.25) per 1000 patients in 2012 (P = 0.009). Following adjustment for baseline clinical and procedural demographics, ischaemic stroke was independently associated with both 30-day mortality (OR 4.92, 3.06-7.92) and in-hospital MACE (OR 3.11, 1.83-5.27). An even greater impact on prognosis was observed with haemorrhagic complications (30-day mortality: OR 13.87, 6.37-30.21), in-hospital MACE (OR 13.50, 6.30-28.92).

CONCLUSIONS: Incident ischaemic stroke complications have increased over time, whilst haemorrhagic stroke complications have decreased, driven through changes in clinical, procedural, drug-treatment, and demographic factors. Both ischaemic and haemorrhagic strokes are rare but devastating complications with high 30-day mortality and in-hospital MACE rates.

Original languageEnglish
Pages (from-to)1618-1628
Number of pages11
JournalEuropean Heart Journal
Volume36
Issue number25
Early online date20 Apr 2015
DOIs
Publication statusPublished - 1 Jul 2015

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Keywords

  • Stroke
  • PCI
  • BCIS
  • Incidence

Cite this

Kwok, C. S., Kontopantelis, E., Myint, P. K., Zaman, A., Berry, C., Keavney, B., Nolan, J., Ludman, P. F., de Belder, M. A., Buchan, I., Mamas, M. A., & British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research (2015). Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007-12. European Heart Journal, 36(25), 1618-1628. https://doi.org/10.1093/eurheartj/ehv113