Peri-procedural stroke increases mortality and MACE risk two-fold in patients undergoing PCI: Study
Australia: The incidence of peri-procedural stroke (PPS) was found to be low among patients who underwent percutaneous coronary intervention (PCI) in a large, multi-center registry. The study, published in the American Journal of Cardiology, however, found a significant incidence of ITS clinical sequelae with a twofold increase in 30-day MACE and all-cause death risk.
Peri-procedural stroke is known to be an important complication in patients who underwent PCI. Post-PCI stroke is associated strongly with higher short- and long-term mortality and can cause life-altering disabilities. However, there is no clarity on the extent to which PPS impacts outcomes and mortality.
Noah Z. Wexler, Department of Cardiology, Western Health, Melbourne, Victoria, Australia, and colleagues categorized consecutive patients who underwent PCI enrolled in the Victorian Cardiac Outcomes Registry (2014 to 2018) into PPS and no PPS groups. 30-day major adverse cardiovascular events (MACEs) (composite of mortality, stent thrombosis, myocardial infarction, and unplanned revascularization) were the primary outcome.
Based on the study, the researchers reported the following:
- Of 50,300 patients, PPS occurred in 0.26% patients (n = 133) (71% ischemic, and 29% hemorrhagic etiology).
- Patients who developed PPS were older (69 vs 66 years) compared with patients with no PPS, and more likely to have pre-existing heart failure (59% vs 29%), chronic kidney disease (33% vs 20%), and previous cerebrovascular disease (13% vs 3.6%).
- Among those with PPS, there was a higher frequency of presentation with ST-elevation myocardial infarction (49% vs 18%) and out-of-hospital cardiac arrest (14% vs 2.2%), PCI by way of femoral access (59% vs 46%), and adjunctive thrombus aspiration (12% vs 3.6%).
- PPS was associated with incident 30-day MACE after multivariable adjustment.
- Utilizing inverse probability of treatment weighting analysis, PPS remained predictive of 30-day MACE driven by higher 30-day mortality.
The researchers conclude, "we found a lower incidence of PPS in this large, multi-center registry; however, its clinical sequelae were significant, with a twofold increased risk of 30-day MACE and all-cause death."
Reference:
Wexler NZ, Vogrin S, Brennan AL, Noaman S, Al-Mukhtar O, Haji K, Bloom JE, Dinh DT, Zheng WC, Shaw JA, Duffy SJ, Lefkovits J, Reid CM, Stub D, Kaye DM, Cox N, Chan W. Adverse Impact of Peri-Procedural Stroke in Patients Who Underwent Percutaneous Coronary Intervention. Am J Cardiol. 2022 Aug 20:S0002-9149(22)00737-8. doi: 10.1016/j.amjcard.2022.06.063. Epub ahead of print. PMID: 35999069.
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