title: Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007-12.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Farr Institute, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
authors.affiliation: Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: Royal Jubilee Hospital, Glasgow, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.affiliation: Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Keavney
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Nolan
authors.affiliation: Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Farr Institute, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK Farr Institute, Institute of Population Health, University of Manchester, Manchester, UK Keele Cardiac Research Group, Institutes of Science and Technology in Medicine and Primary Care, Keele University, Stoke-on-Trent, UK mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000401:mortality; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012008:Recurrence; D019233:Retreatment; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D014852:Wales / Q000453:epidemiology
keywords: Outcomes; PCI; Stroke