NEW YORK (Reuters Health) – Stroke is uncommon after percutaneous coronary intervention (PCI), according to a study of the American College of Cardiology National Cardiovascular Data Registry (NCDR).

“NCDR is the largest contemporary database providing institutions with…the ability to benchmark their care,” Dr. Atul Aggarwal from Comprehensive Cardiovascular Medical Group, Bakersfield, California told Reuters Health in an email.

Also, Dr. Aggarwal said, “Analysis of outcomes provides us ability in real time to provide patients with accurate risk benefit ratio of cardiovascular mechanical and therapeutic outcomes.”

Using registry data from 637 hospitals, Dr. Aggarwal and colleagues assessed clinical characteristics, procedural details, and outcomes of 1540 patients who developed strokes in association with PCI.

This cohort represents 0.22% of the more than 700,000 patients who underwent PCI, the authors report. In-hospital mortality was 30-fold higher for the stroke group compared to PCI patients who did not have strokes.

Patients who suffered strokes were more likely to have periprocedural myocardial infarction, cardiogenic shock, congestive heart failure, and contrast nephropathy, the researchers note.

Mean hospital stay was significantly longer in patients who developed a stroke (10.9 days, versus 3.1 days in patients without stroke).

On multivariate analysis, the factors most strongly associated with stroke were known cerebrovascular disease, older age, admission with unstable angina or myocardial infarction, and need for an intra-aortic balloon pump.

“Occurrence of clinically important neurological deficit…is a very rare event after PCI, but older patients with known cerebrovascular disease, blockages in vessels supplying blood to the brain, and those with big or small heart attacks are especially at risk,” Dr. Aggarwal said.

“When stroke does occur after PCI, outcomes for these patients are devastating,” Dr. Aggarwal added. “PCI strategy may need to be revisited in older acute coronary syndrome patients needing hemodynamic support with intra-aortic pump.”

Reference:
Am J Cardiol 2009;104:349-353.