Stroke complicating percutaneous coronary intervention in patients with acute myocardial infarction

Akio Kawamura, Daniel A. Lombardi, Matthew E. Tilem, David E. Gossman, Thomas C. Piemonte, Richard W. Nesto

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14 Citations (Scopus)

Abstract

Background: Stroke associated with percutaneous coronary intervention (PCI) is a tragic complication. Despite advances in the practice of PCI, the incidence of stroke complicating PCI has not changed over the decades. The objective of the present study was to evaluate incidence and correlates of stroke occurring in patients with myocardial infarction (MI) undergoing PCI. Methods and Results: Stroke was defined as the presence of any new focal neurological deficit lasting ≥24h that occurred anytime during or after PCI until discharge. In 2,281 consecutive patients with PCIs for non-ST-elevation MI, or ST-elevation MI (STEMI), 20 strokes were identified (0.88%). Strokes were ischemic in 95%. On multivariate analyses, ejection fraction ≤30% (odds ratio=4.3, p=0.003) was the only independent predictor for stroke. In patients who developed stroke within 24 h of PCI, PCI of vein grafts was more frequent, and use of glycoprotein IIb/IIIa inhibitor was less frequent. Those patients tended to present late in the course of MI. Stroke found more than 24 h after PCI was related to diabetes, higher serum creatinine, lower ejection fraction, anterior wall STEMI and emergency use of intra-aortic balloon pumps. Conclusions: Low ejection fraction was the only independent predictor for stroke, but risk factors for periprocedural stroke are different from those of stroke occurring more than 24 h after PCI. Upstream use of glycoprotein IIb/IIIa inhibitor might decrease the risk of periprocedural stroke.

Original languageEnglish
Pages (from-to)1370-1375
Number of pages6
JournalCirculation Journal
Volume71
Issue number9
DOIs
Publication statusPublished - 2007 Sep 13

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Keywords

  • Catheterization
  • Cerebral infarction
  • Complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kawamura, A., Lombardi, D. A., Tilem, M. E., Gossman, D. E., Piemonte, T. C., & Nesto, R. W. (2007). Stroke complicating percutaneous coronary intervention in patients with acute myocardial infarction. Circulation Journal, 71(9), 1370-1375. https://doi.org/10.1253/circj.71.1370