Dawson Luke P, Cole Justin A, Lancefield Terase F, Ajani Andrew E, Andrianopoulos Nick, Thrift Amanda G, Clark David J, Brennan Angela L, Freeman Melanie, O'Brien Jessica, Sebastian Martin, Chan William, Shaw James A, Dinh Diem, Reid Christopher M, Duffy Stephen J
Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
Int J Stroke. 2020 Oct;15(8):909-922. doi: 10.1177/1747493020912607. Epub 2020 Apr 4.
Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population.
This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls.
Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005-2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997-1999) and predefined variables assessed for association with inpatient or outpatient stroke.
Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes ( < 0.0001) and mortality ( < 0.0001), as well as 12-month mortality ( < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30-45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients ≥65 years old.
Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the general population, outpatient stroke rates following percutaneous coronary intervention are higher for younger, but not older, patients.
随着经皮冠状动脉介入治疗实践的发展，卒中发生率和风险因素可能会发生变化，目前尚无将经皮冠状动脉介入治疗后的卒中发生率与普通人群进行比较的数据。
本研究旨在确定经皮冠状动脉介入治疗后住院及后续卒中的发生率和风险因素，并与年龄匹配的对照组进行比较。
前瞻性收集墨尔本介入组登记处（2005 - 2015年）22618例行经皮冠状动脉介入治疗患者的数据。将该队列与基于人群的东北墨尔本卒中发生率研究队列（1997 - 1999年）进行比较，并评估预定义变量与住院或门诊卒中的相关性。
住院卒中发生率为0.33%（缺血性卒中占65.3%，出血性卒中占28.0%，病因不明占6.7%），门诊卒中发生率为0.55%。住院和门诊卒中与更高的院内主要不良心血管事件发生率（<0.0001）、死亡率（<0.0001）以及12个月死亡率（<0.0001）相关。与住院卒中独立相关的因素有肾功能损害、ST段抬高型心肌梗死、既往卒中、左心室射血分数30 - 45%以及女性，而与门诊卒中相关的因素有既往卒中、慢性肺病、既往心肌梗死、类风湿关节炎、女性以及高龄。与年龄标准化的基于人群的队列相比，<65岁的经皮冠状动脉介入治疗患者出院后12个月内的卒中发生率较高，而≥65岁患者的卒中发生率较低。
经皮冠状动脉介入治疗后住院卒中风险似乎在很大程度上与就诊时的临床状况相关，而门诊卒中则更多地与年龄和慢性病有关。与普通人群相比，经皮冠状动脉介入治疗后年轻患者的门诊卒中发生率较高，而老年患者则不然。
