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Lookup NU author(s): Professor Azfar Zaman, Professor Bernard Keavney, Dr Mark De Belder
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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.
Author(s): Kwok CS, Kontopantelis E, Myint PK, Zaman A, Berry C, Keavney B, Nolan J, Ludman PF, de Belder MA, Buchan I, Mamas MA, British Cardiovasc Intervention So, Natl Inst Cardiovasc Outcomes Res
Publication type: Article
Publication status: Published
Journal: European Heart Journal
Year: 2015
Volume: 36
Issue: 25
Pages: 1618-1628
Online publication date: 20/04/2015
Acceptance date: 18/03/2015
ISSN (print): 0195-668X
ISSN (electronic): 1522-9645
Publisher: Oxford University Press
URL: http://dx.doi.org/10.1093/eurheartj/ehv113
DOI: 10.1093/eurheartj/ehv113
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