Duke Clinical Research Institute, Durham, NC 27705, USA.
Circ Cardiovasc Interv. 2013 Apr;6(2):176-83. doi: 10.1161/CIRCINTERVENTIONS.112.000159. Epub 2013 Apr 2.
Stroke is a rare but potentially devastating complication of acute myocardial infarction. Little is known about stroke timing, characteristics, and clinical outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI).
We studied 5372 patients enrolled in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. We analyzed stroke incidence, type, timing, and association with the prespecified 90-day clinical outcomes. Cox proportional hazards modeling was performed to assess the relationship between stroke and outcomes, after adjusting baseline characteristics and analyzing stroke as a time-dependent covariate. Stroke occurred in 69 primary patients with PCI (1.3%). A third of strokes were ischemic (n=23; 33%), 12% (n=8) were hemorrhagic, and the remaining 55% (n=38) were of uncertain type. The median (25th, 75th percentile) time of stroke occurrence was 6 (3, 14) days. Overall, 43% of strokes occurred within 48 hours of PCI, and all hemorrhagic strokes occurred within 48 hours. Stroke was associated with an increased risk of 90-day death (unadjusted hazard ratio [HR], 8.0; 95% confidence interval [CI], 4.8-13.5), congestive heart failure (unadjusted HR, 3.2; 95% CI, 1.3-7.8), and 30-day hospital readmission (unadjusted HR, 3.2; 95% CI, 2.0-5.1). After adjustment, stroke was still strongly associated with 90-day death (adjusted HR, 5.6; 95% CI, 3.2-9.8) and the combination end point of death, congestive heart failure, or cardiogenic shock at 90 days (adjusted HR, 2.4; 95% CI, 1.2-4.7).
Stroke is an infrequent complication in the setting of ST-segment elevation myocardial infarction treated with primary PCI but is associated with increased morbidity and mortality. Studies to determine mechanisms that may be responsible for strokes that occur >48 hours from primary PCI are warranted.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00091637.
中风是急性心肌梗死的一种罕见但潜在的严重并发症。对于接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死患者，中风的发生时间、特征和临床结局知之甚少。
我们研究了在急性心肌梗死中评估 Pexelizumab 的效果（APEX-AMI）试验中纳入的 5372 例患者。我们分析了中风的发生率、类型、发生时间以及与预先规定的 90 天临床结局的关系。采用 Cox 比例风险模型评估中风与结局之间的关系，在调整基线特征和将中风作为时变协变量进行分析后。在 69 例接受 PCI 的原发性患者中发生了 6 例中风（1.3%）。三分之一的中风为缺血性（n=23；33%），12%（n=8）为出血性，其余 55%（n=38）为类型不确定。中风发生的中位数（25 百分位数，75 百分位数）时间为 6（3，14）天。总体而言，43%的中风发生在 PCI 后 48 小时内，所有出血性中风均发生在 48 小时内。中风与 90 天死亡风险增加相关（未经调整的危险比[HR]，8.0；95%置信区间[CI]，4.8-13.5）、充血性心力衰竭（未经调整的 HR，3.2；95%CI，1.3-7.8）和 30 天医院再入院（未经调整的 HR，3.2；95%CI，2.0-5.1）。调整后，中风与 90 天死亡（调整后的 HR，5.6；95%CI，3.2-9.8）和 90 天死亡、充血性心力衰竭或心源性休克的联合终点仍有强烈关联（调整后的 HR，2.4；95%CI，1.2-4.7）。
在接受直接 PCI 的 ST 段抬高型心肌梗死患者中，中风是一种罕见的并发症，但与发病率和死亡率的增加相关。有必要开展研究以确定可能导致 PCI 后>48 小时发生中风的机制。
