Michigan Study Evaluates PCI Outcomes in Patients With a History of Cerebrovascular Disease
June 18, 2018—Investigators from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium evaluated outcomes after percutaneous coronary intervention (PCI) in patients with a history of cerebrovascular disease. The findings were published online by Chris Song, MD, et al in Circulation: Cardiovascular Interventions.
The investigators stated that because of shared risk factors between coronary artery disease and cerebrovascular disease, patients with a history of transient ischemic attack (TIA) or stroke are at greater risk of developing coronary artery disease, which may require PCI. However, there is little of research examining outcomes after PCI in these patients.
As summarized in Circulation: Cardiovascular Interventions, the investigators analyzed consecutive patients who underwent percutaneous coronary interventions (PCI) at 47 Michigan hospitals between January 1, 2013, and March 31, 2016. There were 98,730 patients who underwent PCI. Of these, they identified 10,915 patients who had a history of TIA/stroke those patients with a history of transient ischemic attack or stroke.
Propensity score matching was used to adjust for differences in baseline characteristics and compared in-hospital outcomes between patients with and without a history of TIA/stroke. Investigators compared rates of 90-day readmission and long-term mortality in a subset of patients.
After matching (n = 10,618 per group), the investigators found that a history of TIA/stroke was associated with an increased risk of in-hospital stroke (adjusted odds ratio [OR], 2.04; 95% confidence interval [CI], 1.41–2.96; P < .001). There were no differences in the risks of other in-hospital outcomes.
In a subset of patients with postdischarge data, a history of TIA/stroke was associated with increased risks of 90-day readmission (adjusted OR, 1.22; 95% CI, 1.09–1.38; P < .001) and long-term mortality (hazard ratio, 1.23; 95% CI, 1.07–1.43; P = .005).
The study concluded that a history of TIA/stroke, which was common in patients who underwent PCI, was associated with increased risks of in-hospital stroke, 90-day readmission, and long-term mortality. Given the devastating consequences of post-PCI stroke, patients with a history of TIA/stroke should be counseled on this increased risk before undergoing PCI, advised the investigators in Circulation: Cardiovascular Interventions.