B-22 | Predictors of Periprocedural Stroke in Patients Undergoing Cardiac Catheterization

Cerebrovascular accident (CVA) is an important periprocedural complication of left heart catheterization and coronary angiography. We performed a retrospective analysis of subjects who suffered a stroke among patients identified in a contemporary multicenter academic institution cardiac catheterization registry (n=51,064). Patient demographics, comorbidities, and elements of the index hospitalization were collected by review of electronic medical records. Etiology of stroke was categorized as hemorrhagic or ischemic based on review of imaging (CT head and/or MRI brain) at the time of diagnosis. We identified 131 patients with in-hospital stroke following cardiac catheterization (incidence 0.26%). The highest incidence (0.39%) occurred among those who underwent percutaneous coronary intervention (PCI)(n=24,052). By etiology, 70% of strokes were ischemic, 22% were hemorrhagic, and 9% were affected by both etiologies. As compared to the overall cohort, the group that experienced a periprocedural stroke was more likely to have had a prior stroke (18% vs 9.4%, p=0.001), require arterial access cross over (8.5% vs 3.7%, p=0.03), have received mechanical ventricular support (10.7% vs 1.3%, p<0.001), undergo aspiration thrombectomy (6.1% vs 2.2%, p=0.002), present with cardiogenic shock (17.6% vs 1.6%, p<0.001), non-STEMI (35% vs. 21%, p<0.001), or cardiac arrest (7.6% vs 2%, p<0.001). Age, female sex, prior cerebrovascular disease, dyslipidemia, PCI, cardiogenic shock, and mechanical ventricular support were found to be significant predictors of in-hospital stroke in multivariate logistic regression analysis. Stroke is a rare complication following cardiac catheterization, yet it remains clinically significant given the widespread use of coronary angiography. An important understanding of predictors of stroke after catheterization is essential in mitigating this critical complication.