Deans' stroke musings: Periprocedural Stroke After Coronary Revascularization (From the CREDO-Kyoto PCI/CABG Registry Cohort-3)

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, December 7, 2020

Periprocedural Stroke After Coronary Revascularization (From the CREDO-Kyoto PCI/CABG Registry Cohort-3)

Something in here sounds bad, so make sure your doctor guarantees none of this happens post procedure. THIS IS YOUR DOCTOR'S RESPONSIBILITY.

Periprocedural Stroke After Coronary Revascularization (From the CREDO-Kyoto PCI/CABG Registry Cohort-3)

Ko Yamamoto, MD
Masahiro Natsuaki, MD
Takeshi Morimoto, MD, MPH
Kazushige Kadota, MD
Takeshi Kimura, MD
On behalf of theCREDO-Kyoto PCI/CABG Registry Cohort-3 investigators
Show all authors

Published:December 03, 2020DOI:https://doi.org/10.1016/j.amjcard.2020.11.031

Abstract

There is a scarcity of data on incidence, risk factors, especially clinical severity, and long-term prognostic impact of periprocedural stroke after coronary revascularization in contemporary real-world practice. Among 14867 consecutive patients undergoing first coronary revascularization between January 2011 and December 2013 (percutaneous coronary intervention [PCI]: N=13258, and coronary artery bypass grafting [CABG]: N=1609) in the CREDO-Kyoto PCI/CABG registry Cohort-3, we evaluated the details on periprocedural stroke. Periprocedural stroke was defined as stroke within 30 days after the index procedure. Incidence of periprocedural stroke was 0.96% after PCI and 2.13% after CABG (log-rank P<0.001). Proportions of major stroke defined by modified Rankin Scale >=2 at hospital discharge were 68% after PCI, and 77% after CABG. Independent risk factors of periprocedural stroke were acute coronary syndrome (ACS), carotid artery disease, advanced age, heart failure, and end-stage renal disease after PCI, while they were ACS, carotid artery disease, atrial fibrillation, chronic obstructive pulmonary disease, malignancy, and frailty after CABG. There was excess long-term mortality risk of patients with periprocedural stroke relative to those without after both PCI and CABG (HR 1.71 [1.25-2.33], and HR 4.55 [2.79-7.43]). In conclusion, incidence of periprocedural stroke was not negligible not only after CABG, but also after PCI in contemporary real-world practice. Majority of patients with periprocedural stroke had at least mild disability at hospital discharge. ACS and carotid artery disease were independent strong risk factors of periprocedural stroke after both PCI and CABG. Periprocedural stroke was associated with significant long-term mortality risk after both PCI and CABG.