title: Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication.
abstract: Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented.
  
  
  
  The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization).
  
  
  
  A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively.
  
  
  
  Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur.
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.). phyo.myint@abdn.ac.uk.
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Christine
authors.initials: C
authors.lastname: Roffe
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: From the Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK (P.K.M.); Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK (C.S.K., C.R., M.A.M.); Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.); Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (A.Z.); Department of Cardiology, Royal Jubilee Hospital, Glasgow, UK (C.B.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.F.L.); and Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.).
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: elective percutaneous coronary intervention; mortality; nonelective percutaneous coronary intervention; prognosis; risk factor; stroke