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

Am J Cardiol. 2021 Mar 1:142:35-43. doi: 10.1016/j.amjcard.2020.11.031. Epub 2020 Dec 3.

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 14,867 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 Coronary Revascularization Demonstrating Outcome Study in 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, whereas 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 (hazard ratio 1.71 [1.25 to 2.33], and hazard ratio 4.55 [2.79 to 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / surgery
  • Age Factors
  • Aged
  • Atrial Fibrillation / epidemiology
  • Carotid Artery Diseases / epidemiology
  • Coronary Artery Bypass*
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / surgery*
  • Female
  • Frailty / epidemiology
  • Heart Failure / epidemiology
  • Hemorrhagic Stroke / epidemiology*
  • Humans
  • Ischemic Stroke / epidemiology*
  • Japan / epidemiology
  • Kidney Failure, Chronic / epidemiology
  • Male
  • Middle Aged
  • Neoplasms / epidemiology
  • Percutaneous Coronary Intervention*
  • Postoperative Complications / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Risk Factors
  • Stroke / epidemiology