Characteristics of cerebrovascular accidents after percutaneous coronary interventions.
OBJECTIVE
We sought to identify the incidence, predictors, and clinical implications of cerebrovascular accidents (CVAs) after percutaneous coronary interventions (PCIs).


BACKGROUND
Cerebrovascular accidents after PCI, although rare, can be devastating. Limited information exists regarding the characterization of this complication.


METHODS
The study population comprised 20,679 patients who underwent PCI between September 1993 and April 2002. A CVA was defined as a composite of transient ischemic attack (TIA) and stroke. The characteristics of those who had a periprocedural CVA were compared with those who did not.


RESULTS
A CVA occurred in 92 patients (0.30% of procedures). Of these, TIA occurred in 13 patients (0.04%) and stroke in 79 patients (0.25%). On multivariate analysis, patients with this complication more frequently had diabetes mellitus (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1 to 3.0; p = 0.013), hypertension (OR 1.9, 95% CI 1.1 to 3.3; p = 0.033), previous CVA (OR 2.3, 95% CI 1.3 to 4.0; p = 0.0059), and creatinine clearance < or =40 ml/min (OR 3.1, 95% CI 1.8 to 5.2; p < 0.0001). They underwent urgent or emergent procedures (OR 2.7, 95% CI 1.3 to 5.5; p = 0.0092) with more thrombolytic (OR 4.7, 95% CI 2.3 to 9.7; p < 0.0001) and intravenous heparin (OR 1.9, 95% CI 1.1 to 3.4; p = 0.030) use before PCI, and they more often required emergent intra-aortic balloon pump placement (OR 2.2, 95% CI 1.1 to 4.3; p = 0.028). On multivariate analysis, CVA was independently associated with in-hospital death (OR 7.8, 95% CI 4.2 to 14.7; p < 0.0001), acute renal failure (OR 2.8, 95% CI 1.4 to 5.7; p = 0.0042), and new dialysis (OR 3.73, 95% CI 1.01 to 13.8; p = 0.049) after PCI.


CONCLUSIONS
Cerebrovascular accidents after PCI, although rare, are associated with high rates of in-hospital death and acute renal failure, often requiring dialysis.
Dukkipati
Srinivas
S
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
O'Neill
William W
WW
Harjai
Kishore J
KJ
Sanders
William P
WP
Deo
Datinder
D
Boura
Judith A
JA
Bartholomew
Beth A
BA
Yerkey
Michael W
MW
Sadeghi
H Mehrdad
HM
Kahn
Joel K
JK
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000145:classification / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000145:classification* / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome