British Population-Based Study Evaluates Post-PCI Stroke

July 6, 2015—Findings from a large, population-based study of the type-specific incidence, outcomes, and determinants of stroke after percutaneous coronary interventions (PCI) were published by Chun Shing Kwok, MD, et al in the European Heart Journal (2015;36:1618–1628). The study, conducted on behalf of the British Cardiovascular Intervention Society and the United Kingdom’s National Institute for Cardiovascular Outcomes Research, analyzed 426,046 patients who underwent PCI in England and Wales between 2007 and 2012 in the British Cardiovascular Intervention Society's database.

As summarized in the European Heart Journal, the study’s aim was to evaluate temporal changes in stroke complications and their association with mortality and major adverse cardiac event outcomes (MACE, defined as a composite of in-hospital mortality, myocardial infarction or reinfarction, and revascularization) in a national cohort of patients undergoing PCI in England and Wales.

In the study, statistical analyses were performed that evaluated the rates of stroke complications according to the year of PCI. The investigators used multiple logistic regressions to evaluate the odds of 30-day mortality and in-hospital MACE with stroke complications.

The investigators reported that 436 patients (0.1%) sustained an ischemic stroke/transient ischemic attack complication, and 107 patients (0.03%) sustained a hemorrhagic stroke complication. Whereas ischemic stroke/transient ischemic attack complications increased nonlinearly from 0.67 (95% confidence interval, 0.47–0.87) to 1.14 (0.94–1.34) per 1,000 patients between 2007 and 2012 (P = .006), hemorrhagic stroke rates decreased nonlinearly from 0.29 (0.19–0.39) to 0.15 (0.05–0.25) per 1,000 patients in 2012 (P = .009).

After adjustment for baseline clinical and procedural demographics, ischemic stroke was independently associated with both 30-day mortality (odds ratio [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 hemorrhagic complications (30-day mortality: OR, 13.87; 6.37–30.21) and in-hospital MACE (OR, 13.50; 6.30–28.92).

The study concluded that the incident ischemic stroke complications have increased over time while hemorrhagic stroke complications have decreased, driven by changes in clinical, procedural, drug treatment, and demographic factors. Both ischemic and hemorrhagic strokes are rare but devastating complications with high 30-day mortality and in-hospital MACE rates, stated the investigators in the European Heart Journal.