Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication
Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication
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DOI：
10.1161/strokeaha.116.012700
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发表时间：
2016-06-01
期刊：
影响因子：
8.3
通讯作者：
Mamas, Mamas A.
中科院分区：
文献类型：
--
作者：
Myint, Phyo Kyaw;Kwok, Chun Shing;Mamas, Mamas A.
背景和目的：经皮冠状动脉介入治疗（PCI）后卒中是一种严重的并发症，但其决定因素和不同临床环境下PCI后的结果文献很少。方法：使用英国心血管干预学会（BCIS）数据库研究2006年至2013年间在英格兰和威尔士接受PCI治疗的560439例患者。我们研究了缺血性和出血性中风的程序型特定决定因素，以及随后30天死亡率和院内主要不良心血管事件（院内死亡率、心肌梗死或再梗死和重复血运重建术的组合）的可能性。结果：共记录脑卒中705例，其中缺血性卒中占80%。选择性PCI或急性冠状动脉综合征适应症PCI术后卒中与无卒中患者相比存在较高的不良结局风险；在完全校正模型中，择期组30天死亡率和主要心血管不良事件结局的优势比分别为37.90（21.43 ~ 67.05）和21.05(13.25 ~ 33.44)，急性冠脉综合征组的优势比分别为5.00（3.96 ~ 6.31）和6.25（5.03 ~ 7.77）。比较这两种情况下这些结果的几率没有差异；比值比分别为1.24（0.64-2.43）和0.63（0.35-1.15）。结论：出血性和缺血性卒中并发症并不常见，但PCI术后可发生严重并发症，且与择期和急性冠状动脉综合征情况下较差的死亡率和主要不良心血管事件结果独立相关，与卒中类型无关。我们的研究更好地了解了PCI术后卒中的危险因素和预后，使医生能够就PCI术后卒中风险提供更明智的建议，并就发生此类神经系统并发症的结果向患者及其家属提供咨询。
Background and Purpose-Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.Methods-The British Cardiovascular Intervention Society ( BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).Results-A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively.Conclusions-Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.