Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Department of Neuropsychopharmacology, Beijing Institute of Toxicology and Pharmacology, Beijing, China.
Brain Behav. 2023 Apr;13(4):e2927. doi: 10.1002/brb3.2927. Epub 2023 Mar 1.
Stoke after revascularization including both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is an uncommon but devastating complication. Patients with reduced ejection fraction (EF) had an increased risk of stroke after revascularization. However, little is known about the determinants and outcomes of stroke among patients with reduced EF following revascularization.
A cohort study of patients with preoperative reduced EF (≤40%) who received revascularization by either PCI or CABG between January 1, 2005 and December 31, 2014 was performed. Multivariate logistic regression was used to identify independent correlates of stroke. Logistic regression models were applied to evaluate the association of stroke with clinical outcomes.
A total of 1937 patients were enrolled in this study. Of these, 111 (5.7%) patients suffered from stroke during the median 3.5-year follow-up. Older age (odds ratio [OR], 1.03; 95% CI, 1.01-1.05; p = .009), history of hypertension (OR, 1.79; 95% CI, 1.18-2.73; p = .007), and history of stroke (OR, 2.00; 95% CI, 1.19-3.36; p = .008) were found to be independent predictors for stroke. Patients with and without stroke had similar risk of all-cause death (OR, 0.91; 95% CI, 0.59-1.41; p = .670). However, stroke was associated with higher odds ratio of heart failure (HF) hospitalization (OR, 2.77; 95% CI, 1.74-4.40; p < .001) and composite end point (OR, 1.61; 95% CI, 1.07-2.42; p = .021).
Further research appears warranted to minimize the complication of stroke and improve long-term outcomes among patients with reduced EF who underwent such high risk revascularization procedural.
包括经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）在内的血运重建后的卒中是一种罕见但具有破坏性的并发症。射血分数降低（EF）的患者在血运重建后发生卒中的风险增加。然而，对于 EF 降低的血运重建患者，关于卒中的决定因素和结局知之甚少。
对 2005 年 1 月 1 日至 2014 年 12 月 31 日期间接受 PCI 或 CABG 血运重建的术前 EF（≤40%）降低的患者进行了队列研究。多变量逻辑回归用于确定卒中的独立相关因素。应用逻辑回归模型评估卒中与临床结局的相关性。
共有 1937 例患者纳入本研究。其中，111 例（5.7%）患者在中位 3.5 年随访期间发生卒中。年龄较大（比值比[OR]，1.03；95%置信区间[CI]，1.01-1.05；p=0.009）、高血压病史（OR，1.79；95%CI，1.18-2.73；p=0.007）和卒中病史（OR，2.00；95%CI，1.19-3.36；p=0.008）是卒中的独立预测因素。发生卒中和未发生卒中的患者全因死亡风险相似（OR，0.91；95%CI，0.59-1.41；p=0.670）。然而，卒中与心力衰竭（HF）住院（OR，2.77；95%CI，1.74-4.40；p<0.001）和复合终点（OR，1.61；95%CI，1.07-2.42；p=0.021）的发生风险更高。
对于 EF 降低且接受高风险血运重建治疗的患者，进一步的研究似乎是必要的，以减少卒中并发症并改善其长期结局。
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