Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Neurocritical Care, Thomas Jefferson University Hospital, Philadelphia, PA.
J Am Heart Assoc. 2017 Dec 2;6(12):e006900. doi: 10.1161/JAHA.117.006900.
Studies on stroke risk following cardiac procedures addressed only perioperative and long-term risk following limited higher-risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions.
The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age-adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic valve replacement and coronary artery bypass graft versus percutaneous coronary intervention. Procedures and diagnoses were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes. After cardiac procedures, 90-day ischemic stroke readmission rate was highest after transcatheter aortic valve replacement (2.05%); 90-day hemorrhagic stroke rate was highest after left ventricular assist device placement (0.09%). The hazard ratio for ischemic stroke after transcatheter aortic valve replacement, compared with surgical aortic valve replacement, in fully adjusted Cox models was 1.86 (95% confidence interval, 1.12-3.08; =0.016) and 6.17 (95% confidence interval, 1.97-19.33; =0.0018) for hemorrhagic stroke. There was no difference between coronary artery bypass graft and percutaneous coronary intervention.
We demonstrated elevated readmission rates for ischemic and hemorrhagic stroke in the intermediate 30-, 60-, and 90-day risk periods following common cardiac procedures. Furthermore, we found an elevated risk of stroke after transcatheter aortic valve replacement compared with surgical aortic valve replacement up to 1 year.
心脏手术后的中风风险研究仅针对围手术期和有限高风险手术后的长期风险，可推广性较差，且通常未能按中风类型进行分层。我们计算了心脏手术后中期风险期间的中风风险与常见非心脏手术和医疗入院相比。
全国再入院数据库包含了 2013 年美国 49%的入院数据。我们比较了出院后 90 天内的年龄调整后中风再入院率。我们使用 Cox 回归计算了比较经导管主动脉瓣置换术与外科主动脉瓣置换术和冠状动脉旁路移植术与经皮冠状动脉介入治疗的中风风险的风险比，最长可达 1 年。通过国际疾病分类，第九修订版，临床修正代码来识别手术和诊断。心脏手术后，90 天内缺血性中风再入院率最高的是经导管主动脉瓣置换术（2.05%）；90 天内出血性中风率最高的是左心室辅助装置放置（0.09%）。在完全调整后的 Cox 模型中，经导管主动脉瓣置换术与外科主动脉瓣置换术相比，缺血性中风的风险比为 1.86（95%置信区间，1.12-3.08；=0.016），出血性中风的风险比为 6.17（95%置信区间，1.97-19.33；=0.0018）。冠状动脉旁路移植术和经皮冠状动脉介入治疗之间没有差异。
我们在常见心脏手术后的 30、60 和 90 天的中期风险期间，观察到缺血性和出血性中风的再入院率升高。此外，我们发现经导管主动脉瓣置换术与外科主动脉瓣置换术相比，中风风险在 1 年内升高。
