Stroke After Percutaneous Coronary Intervention in the Era of Transradial Intervention

Satoshi Shoji, Shun Kosaka, Hiraku Kumamaru, Mitsuaki Sawano, Yasuyuki Shiraishi, Ikuko Ueda, Shigetaka Noma, Masahiro Suzuki, Yohei Numasawa, Kentaro Hayashida, Shinsuke Yuasa, Hiroaki Miyata, Keiichi Fukuda

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Periprocedural stroke is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Transradial intervention (TRI) is more beneficial than transfemoral intervention for periprocedural bleeding and acute kidney injuries, but its effect on periprocedural stroke has not been fully investigated. Our study aimed to assess risk predictors of periprocedural stroke according to PCI access site. METHODS AND RESULTS: Between 2008 and 2016, 17 966 patients undergoing PCI were registered in a prospective multicenter database. Periprocedural stroke was defined as loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms lasting at least 24 hours after onset. Periprocedural stroke was observed in 42 patients (0.3%). Stroke patients were older and had a higher incidence of chronic kidney disease, peripheral artery disease, and acute coronary syndrome but were less likely to undergo TRI. Multivariable logistic regression analysis revealed TRI (odds ratio; 0.33; 95% CI, 0.16-0.71; P=0.004) was significantly associated with a lower occurrence of periprocedural stroke. Finally, propensity score-matching analysis showed that TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention (0.1% versus 0.4%; P=0.014). According to our sensitivity analysis, this finding was robust to the presence of an unmeasured confounder in almost all plausible scenarios. CONCLUSIONS: TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention. Increased TRI use may reduce overall PCI complications and should be recommended as the optimal access site for both urgent/emergent and elective PCIs.

Original languageEnglish
Pages (from-to)e006761
JournalCirculation. Cardiovascular interventions
Volume11
Issue number12
DOIs
Publication statusPublished - 2018 Dec 1

Fingerprint

Percutaneous Coronary Intervention
Stroke
Propensity Score
Peripheral Arterial Disease
Acute Coronary Syndrome
Chronic Renal Insufficiency
Acute Kidney Injury
Logistic Models
Odds Ratio
Regression Analysis
Databases
Hemorrhage
Incidence

Keywords

  • percutaneous coronary intervention
  • propensity score matching
  • sensitivity analysis
  • stroke
  • transradial intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Stroke After Percutaneous Coronary Intervention in the Era of Transradial Intervention. / Shoji, Satoshi; Kosaka, Shun; Kumamaru, Hiraku; Sawano, Mitsuaki; Shiraishi, Yasuyuki; Ueda, Ikuko; Noma, Shigetaka; Suzuki, Masahiro; Numasawa, Yohei; Hayashida, Kentaro; Yuasa, Shinsuke; Miyata, Hiroaki; Fukuda, Keiichi.

In: Circulation. Cardiovascular interventions, Vol. 11, No. 12, 01.12.2018, p. e006761.

Research output: Contribution to journalArticle

Shoji, Satoshi ; Kosaka, Shun ; Kumamaru, Hiraku ; Sawano, Mitsuaki ; Shiraishi, Yasuyuki ; Ueda, Ikuko ; Noma, Shigetaka ; Suzuki, Masahiro ; Numasawa, Yohei ; Hayashida, Kentaro ; Yuasa, Shinsuke ; Miyata, Hiroaki ; Fukuda, Keiichi. / Stroke After Percutaneous Coronary Intervention in the Era of Transradial Intervention. In: Circulation. Cardiovascular interventions. 2018 ; Vol. 11, No. 12. pp. e006761.
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AU - Shoji, Satoshi

AU - Kosaka, Shun

AU - Kumamaru, Hiraku

AU - Sawano, Mitsuaki

AU - Shiraishi, Yasuyuki

AU - Ueda, Ikuko

AU - Noma, Shigetaka

AU - Suzuki, Masahiro

AU - Numasawa, Yohei

AU - Hayashida, Kentaro

AU - Yuasa, Shinsuke

AU - Miyata, Hiroaki

AU - Fukuda, Keiichi

PY - 2018/12/1

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N2 - BACKGROUND: Periprocedural stroke is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Transradial intervention (TRI) is more beneficial than transfemoral intervention for periprocedural bleeding and acute kidney injuries, but its effect on periprocedural stroke has not been fully investigated. Our study aimed to assess risk predictors of periprocedural stroke according to PCI access site. METHODS AND RESULTS: Between 2008 and 2016, 17 966 patients undergoing PCI were registered in a prospective multicenter database. Periprocedural stroke was defined as loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms lasting at least 24 hours after onset. Periprocedural stroke was observed in 42 patients (0.3%). Stroke patients were older and had a higher incidence of chronic kidney disease, peripheral artery disease, and acute coronary syndrome but were less likely to undergo TRI. Multivariable logistic regression analysis revealed TRI (odds ratio; 0.33; 95% CI, 0.16-0.71; P=0.004) was significantly associated with a lower occurrence of periprocedural stroke. Finally, propensity score-matching analysis showed that TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention (0.1% versus 0.4%; P=0.014). According to our sensitivity analysis, this finding was robust to the presence of an unmeasured confounder in almost all plausible scenarios. CONCLUSIONS: TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention. Increased TRI use may reduce overall PCI complications and should be recommended as the optimal access site for both urgent/emergent and elective PCIs.

AB - BACKGROUND: Periprocedural stroke is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Transradial intervention (TRI) is more beneficial than transfemoral intervention for periprocedural bleeding and acute kidney injuries, but its effect on periprocedural stroke has not been fully investigated. Our study aimed to assess risk predictors of periprocedural stroke according to PCI access site. METHODS AND RESULTS: Between 2008 and 2016, 17 966 patients undergoing PCI were registered in a prospective multicenter database. Periprocedural stroke was defined as loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms lasting at least 24 hours after onset. Periprocedural stroke was observed in 42 patients (0.3%). Stroke patients were older and had a higher incidence of chronic kidney disease, peripheral artery disease, and acute coronary syndrome but were less likely to undergo TRI. Multivariable logistic regression analysis revealed TRI (odds ratio; 0.33; 95% CI, 0.16-0.71; P=0.004) was significantly associated with a lower occurrence of periprocedural stroke. Finally, propensity score-matching analysis showed that TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention (0.1% versus 0.4%; P=0.014). According to our sensitivity analysis, this finding was robust to the presence of an unmeasured confounder in almost all plausible scenarios. CONCLUSIONS: TRI was associated with a reduced risk of periprocedural stroke compared with transfemoral intervention. Increased TRI use may reduce overall PCI complications and should be recommended as the optimal access site for both urgent/emergent and elective PCIs.

KW - percutaneous coronary intervention

KW - propensity score matching

KW - sensitivity analysis

KW - stroke

KW - transradial intervention

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