Percutaneous Coronary Intervention
Percutaneous Coronary Intervention
Background: Percutaneous coronary intervention (PCI) is increasingly used in patients with high-risk baseline characteristics. A prior stroke may identify patients who have a higher risk for post-PCI complications. However, no comparative data exist on post-PCI outcomes of patients with or without prior stroke.
Methods: Review of a PCI database of 9,088 consecutive PCIs from 7/97 to 12/02 identified 812 PCIs in patients with a history of prior stroke and 8,044 PCIs without prior stroke.
Results: Patients with prior stroke had high-risk baseline characteristics [diabetes, hypertension, hyperlipidemia, smoking, peripheral arterial disease, congestive heart failure, chronic renal failure, history of prior myocardial infarction and prior coronary artery bypass graft (CABG)] and high-risk coronary anatomy (p < 0.001 for each one). The triple composite (death, myocardial infarction and emergent CABG) and the triple composite plus post-PCI stroke were higher in patients with prior stroke (11.2% vs. 4.8%; p < 0.001; z = 7.617 and 12.1% vs. 5.0%; p < 0.001; z = 8.271, respectively.
Conclusion: Patients with prior stroke constitute a high-risk PCI cohort with higher rates of in-hospital adverse events. A prior stroke history should be considered in evaluating potential candidates for PCI.
Percutaneous coronary intervention (PCI) is increasingly used in patients with high-risk baseline characteristics. A prior stroke may identify patients who are at higher risk for post-PCI complications. However, no comparative data exist on post-PCI outcomes of patients with or without prior stroke. The benefits of PCI among these sub-groups may be partially offset by increased complication rates. Recent studies have reported improvements in angiographic and clinical success rates of PCI among high-risk groups, largely due to the availability of stents and glycoprotein IIb/IIIa (GPIIb/IIIa) receptor inhibitors. Nevertheless, GPIIb/IIIa inhibitors are cautiously used in patients with prior stroke due to the fear of intracranial bleeding (ICH). The objective of this study was to identify the frequency of prior stroke among consecutive PCIs and to determine the association of cardiovascular risk factors and PCI-related ischemic complications in patients with prior stroke.
Background: Percutaneous coronary intervention (PCI) is increasingly used in patients with high-risk baseline characteristics. A prior stroke may identify patients who have a higher risk for post-PCI complications. However, no comparative data exist on post-PCI outcomes of patients with or without prior stroke.
Methods: Review of a PCI database of 9,088 consecutive PCIs from 7/97 to 12/02 identified 812 PCIs in patients with a history of prior stroke and 8,044 PCIs without prior stroke.
Results: Patients with prior stroke had high-risk baseline characteristics [diabetes, hypertension, hyperlipidemia, smoking, peripheral arterial disease, congestive heart failure, chronic renal failure, history of prior myocardial infarction and prior coronary artery bypass graft (CABG)] and high-risk coronary anatomy (p < 0.001 for each one). The triple composite (death, myocardial infarction and emergent CABG) and the triple composite plus post-PCI stroke were higher in patients with prior stroke (11.2% vs. 4.8%; p < 0.001; z = 7.617 and 12.1% vs. 5.0%; p < 0.001; z = 8.271, respectively.
Conclusion: Patients with prior stroke constitute a high-risk PCI cohort with higher rates of in-hospital adverse events. A prior stroke history should be considered in evaluating potential candidates for PCI.
Percutaneous coronary intervention (PCI) is increasingly used in patients with high-risk baseline characteristics. A prior stroke may identify patients who are at higher risk for post-PCI complications. However, no comparative data exist on post-PCI outcomes of patients with or without prior stroke. The benefits of PCI among these sub-groups may be partially offset by increased complication rates. Recent studies have reported improvements in angiographic and clinical success rates of PCI among high-risk groups, largely due to the availability of stents and glycoprotein IIb/IIIa (GPIIb/IIIa) receptor inhibitors. Nevertheless, GPIIb/IIIa inhibitors are cautiously used in patients with prior stroke due to the fear of intracranial bleeding (ICH). The objective of this study was to identify the frequency of prior stroke among consecutive PCIs and to determine the association of cardiovascular risk factors and PCI-related ischemic complications in patients with prior stroke.
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