title: Trends, predictors, and outcomes of cerebrovascular events related to percutaneous coronary intervention: a 16-year single-center experience.
abstract: OBJECTIVE
  We sought to determine trends, predictors, in-hospital and long-term outcomes of cerebrovascular events (CVE) related to percutaneous coronary intervention (PCI) over a 16-year period.
  
  
  BACKGROUND
  Despite a temporal increase in patient risk profile and procedural complexity, rates of PCI-related mortality and myocardial infarction have decreased. Temporal trends, characterization, and outcomes after PCI-related CVE in the contemporary era remain unknown.
  
  
  METHODS
  We performed a retrospective study of 24,126 PCI hospitalizations in 19,165 unique patients, between January 1, 1994, and December 31, 2009, and compared those who suffered an in-hospital PCI-CVE with the remaining control population who did not.
  
  
  RESULTS
  The incidence of CVE was 0.37% (n = 89), of which 22% were transient ischemic attacks. Temporal analysis showed no significant trend in incidence over 16 years (p = 0.47). Multiple clinical and angiographic predictors of PCI-CVE were identified. Multivariate logistic regression analyses revealed age, female sex, myocardial infarction within 7 days before PCI, and history of prior CVE as independent predictors of PCI-CVE, with a 19-fold increase in incidence in patients over 80 with a prior CVE history. In-hospital mortality was 19% after PCI-CVE versus 2% in controls (p < 0.001). Those who survived PCI-CVE exhibited a markedly higher risk of mortality over the subsequent 10 years (p < 0.001).
  
  
  CONCLUSIONS
  The incidence of PCI-related CVE has remained steady over a 16-year period, despite an increase in the baseline risk profile. Age and prior history of CVE were the strongest independent demographic predictors. PCI-CVE had a markedly adverse impact on early and late outcomes.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Hoffman
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Riyaz
authors.initials: R
authors.lastname: Bashir
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome