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

Shing Kwok, Chun; Kontopantelis, Evangelos; Myint, Phyo K.; Zaman, Azfar; Berry, Colin; Keavney, Bernard; Nolan, Jim; Ludman, Peter F.; de Belder, Mark A.; Buchan, Iain; Mamas, Mamas

Authors

Chun Shing Kwok

Evangelos Kontopantelis

Phyo K. Myint

Azfar Zaman

Colin Berry

Bernard Keavney

Peter F. Ludman

Mark A. de Belder

Iain Buchan



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.

Journal Article Type Article
Acceptance Date Mar 18, 2015
Online Publication Date Apr 20, 2015
Publication Date Jul 1, 2015
Publicly Available Date Mar 29, 2024
Journal European Heart Journal
Print ISSN 0195-668X
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 36
Issue 25
Pages 1618 -1628
DOI https://doi.org/10.1093/eurheartj/ehv113
Keywords Stroke, Outcomes, PCI
Publisher URL http://dx.doi.org/10.1093/eurheartj/ehv113