Fuchs Shmuel, Stabile Eugenio, Kinnaird Timothy D, Mintz Gary S, Gruberg Luis, Canos Daniel A, Pinnow Ellen E, Kornowski Ran, Suddath William O, Satler Lowell F, Pichard Augusto D, Kent Kenneth M, Weissman Neil J
Cardiovascular Research Institute and the Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC 20010, USA.
Circulation. 2002 Jul 2;106(1):86-91. doi: 10.1161/01.cir.0000020678.16325.e0.
Stroke associated with percutaneous coronary intervention (PCI) is an infrequent although devastating complication. We investigated the incidence, predictors, and prognostic impact of periprocedural stroke in unselected patients undergoing PCI.
A total of 9662 patients who underwent 12 407 PCIs between January 1990 and July 1999 were retrospectively studied. Stroke was diagnosed in 43 patients (0.38% of procedures). Patients with stroke were older (72+/-11 versus 64+/-11 years, P<0.001), had lower left ventricular ejection fraction (42+/-12 versus 46+/-13%, P=0.04) and more diabetes (39.5% versus 27.2%, P=0.07), and experienced a higher rate of intraprocedural complications necessitating emergency use of intra-aortic balloon pump (IABP) (23.3% versus 3.3%, P<0.001). In-hospital mortality (37.2% versus 1.1%, P<0.001) and 1-year mortality (56.1% versus 6.5%, P<0.001) were higher in patients with stroke. Compared with hemorrhagic stroke, patients with ischemic stroke had higher rate of in-hospital major adverse cardiac events (57.1% versus 25%, P=0.037). Multivariate logistic regression analysis identified emergency use of IABP as the strongest predictors for stroke (OR=9.6, CI 3.9 to 23.9, P<0.001), followed by prophylactic use of IABP (OR=5.1), age >80 years (OR=3.2, compared with age <50 years), and vein graft intervention (OR=2.7).
Stroke associated with contemporary PCI is associated with substantial increased mortality. Elderly patients who experience intraprocedural complications necessitating the use of IABP are at particularly high risk.
经皮冠状动脉介入治疗（PCI）相关的卒中是一种虽不常见但具有毁灭性的并发症。我们调查了未选择的接受PCI患者围手术期卒中的发生率、预测因素及预后影响。
对1990年1月至1999年7月期间接受12407次PCI的9662例患者进行回顾性研究。43例患者（占手术的0.38%）被诊断为卒中。卒中患者年龄更大（72±11岁对64±11岁，P<0.001），左心室射血分数更低（42±12%对46±13%，P=0.04），糖尿病患者更多（39.5%对27.2%，P=0.07），且术中需要紧急使用主动脉内球囊反搏（IABP）的并发症发生率更高（23.3%对3.3%，P<0.001）。卒中患者的住院死亡率（37.2%对1.1%，P<0.001）和1年死亡率（56.1%对6.5%，P<0.001）更高。与出血性卒中相比，缺血性卒中患者的住院主要不良心脏事件发生率更高（57.1%对25%，P=0.037）。多因素逻辑回归分析确定紧急使用IABP是卒中的最强预测因素（OR=9.6，CI 3.9至23.9，P<0.001），其次是预防性使用IABP（OR=5.1）、年龄>80岁（与年龄<50岁相比，OR=3.2）以及静脉桥血管介入（OR=2.7）。
当代PCI相关的卒中与死亡率大幅增加相关。术中出现需要使用IABP的并发症的老年患者风险尤其高。
