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)
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.
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