Ischaemic stroke complicating primary percutaneous coronary intervention in patients with ST elevation myocardial infarction.
OBJECTIVE
We sought to determine the in-hospital incidence and predictors of ischaemic stroke in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).


METHODS
We reviewed 2638 consecutive patients undergoing 2722 pimary PCI procedures for STEMI during in-hospital stay. Stroke was defined as any new focal neurological deficit lasting > or =24 h, occurring anytime during or after PCI until discharge. Patients with haemorrhagic stroke were excluded. Clinical characteristics and in-hospital outcome were analysed regarding ischaemic stroke in patients undergoing primary PCI.


RESULTS
Ischaemic stroke was observed in 20 of the 2722 procedures, an incidence of 0.73%. Patients with ischaemic stroke were older than patients without stroke (mean age 67 +/- 9.6 vs. 56.6 +/- 11.8, P < 0.001). Compared to patients without stroke, female gender, diabetes and hypertension were more prevalent in patients with stroke. Ischaemic stroke was found to be a powerful independent predictor of in-hospital cardiovascular mortality (odds ratio [OR] 6.32, 1.15-34.7; P < 0.001). Left ventricular ejection fraction (LVEF) < 35% (OR 3.13, P = 0.04), contrast-induced nephropathy (OR 2.91, P = 0.04) and tirofiban use (OR 0.23, P = 0.02) were the independent predictors for in-hospital ischaemic stroke.


CONCLUSIONS
The present study shows that the incidence of ischaemic stroke in patients undergoing PCI for STEMI is higher and ischaemic stroke increases in-hospital mortality in these patients. Moreover, LVEF < 35% and contrast-induced nephropathy were independent predictors of ischaemic stroke, whereas tirofiban use demonstrated a protective effect to this potentially catastrophic complication.
Dept. of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Training and Research Hospital, Istanbul, Turkey. drmerg@hotmail.com
Mehmet
M
Ergelen
Sevket
S
Gorgulu
Huseyin
H
Uyarel
Tugrul
T
Norgaz
Erkan
E
Ayhan
Emre
E
Akkaya
Rabia
R
Ergelen
Gokhan
G
Cicek
Murat
M
Ugur
Ozer
O
Soylu
Tuna
T
Tezel
Ibrahim
I
Yekeler
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D020520:Brain Infarction / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013318:Stroke Volume