Academic Foundation Programme, North Middlesex University Hospital NHS Trust, United Kingdom.
Department of Cardiology, National University Heart Centre Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Stroke Cerebrovasc Dis. 2021 Jul;30(7):105786. doi: 10.1016/j.jstrokecerebrovasdis.2021.105786. Epub 2021 Apr 14.
Non-emergency percutaneous coronary intervention (PCI) has lower risk of stroke than emergency PCI. With increasing elective PCI and increasing risk of stroke after PCI, risk factors for stroke or transient ischaemic attack (TIA) in non-emergency PCI and long-term outcomes needs to be better characterised. We aim to identify risk factors for cerebrovascular accidents in patients undergoing non-emergency PCI and long-term outcomes after stroke or TIA.
A retrospective cohort study was performed on 1724 consecutive patients who underwent non-emergency PCI for non-ST-segment elevation myocardial infarction (NSTEMI), unstable and stable angina. The primary outcomes measured were stroke or TIA, myocardial infarction (MI) and all-cause death.
Upon mean follow-up of 3.71 (SD 0.97) years, 70 (4.1%) had subsequent ischaemic stroke or TIA, and they were more likely to present with NSTEMI (50 [71.4%] vs 892 [54.0%], OR 2.13 [1.26-3.62], p = 0.004) and not stable angina (19 [27.1%] vs 648 [39.2%], OR 0.58 [0.34-0.99]). Femoral access was associated with subsequent stroke or TIA compared to radial access (OR 2.10 [1.30-3.39], p < 0.002). Previous stroke/TIA was associated with subsequent stroke/TIA (p < 0.001), death (p < 0.001) and MI (p = 0.002). Furthermore, subsequent stroke/TIA was significantly associated with subsequent MI (p = 0.006), congestive cardiac failure (CCF) (p = 0.008) and death (p < 0.001).
In patients undergoing non-emergency PCI, previous stroke/TIA predicted post-PCI ischaemic stroke/TIA, which was associated with death, MI, CCF.
非紧急经皮冠状动脉介入治疗（PCI）的中风风险低于紧急 PCI。随着择期 PCI 的增加以及 PCI 后中风风险的增加，非紧急 PCI 中中风或短暂性脑缺血发作（TIA）的危险因素以及长期预后需要更好地确定。我们旨在确定接受非紧急 PCI 的患者中风的危险因素以及中风或 TIA 后的长期预后。
对 1724 例因非 ST 段抬高型心肌梗死（NSTEMI）、不稳定型和稳定型心绞痛而行非紧急 PCI 的连续患者进行回顾性队列研究。主要测量的结局为中风或 TIA、心肌梗死（MI）和全因死亡。
平均随访 3.71（SD 0.97）年后，70 例（4.1%）发生后续缺血性中风或 TIA，他们更有可能表现为 NSTEMI（50[71.4%] vs 892[54.0%]，OR 2.13[1.26-3.62]，p=0.004）而非稳定型心绞痛（19[27.1%] vs 648[39.2%]，OR 0.58[0.34-0.99]）。与桡动脉入路相比，股动脉入路与后续中风或 TIA 相关（OR 2.10[1.30-3.39]，p<0.002）。既往中风/TIA 与后续中风/TIA（p<0.001）、死亡（p<0.001）和 MI（p=0.002）相关。此外，后续中风/TIA 与随后的 MI（p=0.006）、充血性心力衰竭（CCF）（p=0.008）和死亡（p<0.001）显著相关。
在接受非紧急 PCI 的患者中，既往中风/TIA 预测 PCI 后缺血性中风/TIA，与死亡、MI、CCF 相关。
