Stroke complicating percutaneous coronary intervention in patients with acute myocardial infarction.
BACKGROUND
Stroke associated with percutaneous coronary intervention (PCI) is a tragic complication. Despite advances in the practice of PCI, the incidence of stroke complicating PCI has not changed over the decades. The objective of the present study was to evaluate incidence and correlates of stroke occurring in patients with myocardial infarction (MI) undergoing PCI.


RESULTS
Stroke was defined as the presence of any new focal neurological deficit lasting > or =24 h that occurred anytime during or after PCI until discharge. In 2,281 consecutive patients with PCIs for non-ST-elevation MI, or ST-elevation MI (STEMI), 20 strokes were identified (0.88%). Strokes were ischemic in 95%. On multivariate analyses, ejection fraction < or =30% (odds ratio =4.3, p=0.003) was the only independent predictor for stroke. In patients who developed stroke within 24 h of PCI, PCI of vein grafts was more frequent, and use of glycoprotein IIb/IIIa inhibitor was less frequent. Those patients tended to present late in the course of MI. Stroke found more than 24 h after PCI was related to diabetes, higher serum creatinine, lower ejection fraction, anterior wall STEMI and emergency use of intra-aortic balloon pumps.


CONCLUSIONS
Low ejection fraction was the only independent predictor for stroke, but risk factors for periprocedural stroke are different from those of stroke occurring more than 24 h after PCI. Upstream use of glycoprotein IIb/IIIa inhibitor might decrease the risk of periprocedural stroke.
Kawamura
Akio
A
Department of Cardiovascular Medicine, Keio University School of Medicine, Tokyo, Japan. kawamura@cpnet.med.keio.ac.jp
Lombardi
Daniel A
DA
Tilem
Matthew E
ME
Gossman
David E
DE
Piemonte
Thomas C
TC
Nesto
Richard W
RW
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003404:Creatinine / Q000097:blood*; D003925:Diabetic Angiopathies / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D013318:Stroke Volume; D013997:Time Factors; D019737:Transplants
D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003404:Creatinine