Key result
Ischaemic stroke complicating primary PCI for STEMI is linked to ~6-fold higher in-hospital CV mortality.
Why the study?
The incidence and predictors of ischaemic stroke in patients with STEMI undergoing primary PCI during in-hospital stay were not well defined.
Cohort (n=2,638)
Odds Ratio: 6.32 (95% CI 1.15–34.7)
p-value: p=<0.001
Ischaemic stroke is a rare (0.73%) but catastrophic complication of primary PCI for STEMI that significantly increases in-hospital mortality, with LVEF <35% and contrast-induced nephropathy identified as key risk factors.
Stroke complicating primary PCI for STEMI signals high in-hospital mortality risk; supports targeted prevention research but should not yet change practice.
OBJECTIVE: We sought to determine the in-hospital incidence and predictors of ischaemic stroke in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: We reviewed 2638 consecutive patients undergoing 2722 pimary PCI procedures for STEMI during in-hospital stay. Stroke was defined as any new focal neurological deficit lasting > or =24 h, occurring anytime during or after PCI until discharge. Patients with haemorrhagic stroke were excluded. Clinical characteristics and in-hospital outcome were analysed regarding ischaemic stroke in patients undergoing primary PCI. RESULTS: Ischaemic stroke was observed in 20 of the 2722 procedures, an incidence of 0.73%. Patients with ischaemic stroke were older than patients without stroke (mean age 67 +/- 9.6 vs. 56.6 +/- 11.8, P < 0.001). Compared to patients without stroke, female gender, diabetes and hypertension were more prevalent in patients with stroke. Ischaemic stroke was found to be a powerful independent predictor of in-hospital cardiovascular mortality (odds ratio [OR] 6.32, 1.15-34.7; P < 0.001). Left ventricular ejection fraction (LVEF) < 35% (OR 3.13, P = 0.04), contrast-induced nephropathy (OR 2.91, P = 0.04) and tirofiban use (OR 0.23, P = 0.02) were the independent predictors for in-hospital ischaemic stroke. CONCLUSIONS: The present study shows that the incidence of ischaemic stroke in patients undergoing PCI for STEMI is higher and ischaemic stroke increases in-hospital mortality in these patients. Moreover, LVEF < 35% and contrast-induced nephropathy were independent predictors of ischaemic stroke, whereas tirofiban use demonstrated a protective effect to this potentially catastrophic complication.
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Ergelen et al. (2009) conducted a cohort in ST elevation myocardial infarction (STEMI) (n=2,638). Ischaemic stroke vs. No ischaemic stroke was evaluated on in-hospital cardiovascular mortality (OR 6.32, 95% CI 1.15-34.7, p=<0.001). Ischaemic stroke complicating primary PCI for STEMI occurred in 0.73% of procedures and independently predicted in-hospital cardiovascular mortality (OR 6.32; 95% CI 1.15-34.7; P<0.001).
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