Key result
In STEMI patients undergoing primary PCI, the use of ≥4 catheters was significantly associated with increased risk of in-hospital AIS/TIA (OR 3.715; 95% CI 1.831–7.537; p<0.001).
Why the study?
AIS is a critical complication after STEMI whose risk may be amplified by primary PCI, but factors associated with in-hospital AIS/TIA in this setting needed investigation.
Observational (n=941)
Odds Ratio: 3.715 (95% CI 1.831–7.537)
p-value: p=<0.001
In STEMI patients undergoing primary PCI, in-hospital AIS/TIA is associated with high mortality and specific risk factors including cardiogenic shock, new-onset AF, trans-femoral approach, use of ≥4 catheters, and major bleeding.
May help identify high-risk STEMI patients for closer monitoring post-PCI; leaves open need for prospective validation.
Background: Acute ischemic stroke (AIS) is a rare but critical complication following ST-elevation myocardial infarction (STEMI). The risk of AIS or transient ischemic attack (TIA) may be amplified by invasive procedures, including primary percutaneous coronary intervention (PCI). This study aimed to investigate the factors associated with in-hospital AIS/TIA in patients with STEMI who required primary PCI. Methods: We included 941 STEMI patients who underwent primary PCI and divided them into an AIS/TIA group (n = 39) and a non-AIS/TIA group (n = 902), according to new-onset AIS/TIA. The primary interest was to find the factors associated with AIS/TIA by multivariate logistic regression analysis. We also compared clinical outcomes between the AIS/TIA and non-AIS/TIA groups. Results: The incidence of in-hospital deaths was significantly higher in the AIS/TIA group (46.2%) than in the non-AIS/TIA group (6.3%) (p < 0.001). Multivariate analysis revealed that cardiogenic shock (OR 3.228, 95% CI 1.492–6.986, p = 0.003), new-onset atrial fibrillation (AF) (OR 2.280, 95% CI 1.033–5.031, p = 0.041), trans-femoral approach (OR 2.336, 95% CI 1.093–4.992, p = 0.029), use of ≥4 catheters (OR 3.715, 95% CI 1.831–7.537, p < 0.001), and bleeding academic research consortium (BARC) type 3 or 5 bleeding (OR 2.932, 95% CI 1.256–6.846, p = 0.013) were significantly associated with AIS/TIA. Conclusion: In STEMI patients with primary PCI, new-onset AIS/TIA was significantly associated with cardiogenic shock, new-onset AF, trans-femoral approach, the use of ≥4 catheters, and BARC type 3 or 5 bleeding. We should recognize these modifiable and unmodifiable risk factors for AIS/TIA in the treatment of STEMI.
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Murakami et al. (2023) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=941). Use of ≥4 catheters vs. Use of <4 catheters was evaluated on In-hospital AIS/TIA (OR 3.715, 95% CI 1.831-7.537, p=<0.001). In STEMI patients undergoing primary PCI, the use of ≥4 catheters was significantly associated with increased risk of in-hospital AIS/TIA (OR 3.715; 95% CI 1.831–7.537; p<0.001).
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