Stroke During Primary Percutaneous Coronary Intervention: Incidence and Long-Term Outcomes from the Midwest STEMI Consortium
Presenter
Michael S Megaly, M.D., FSCAI, Henry Ford Hospital, Bossier City, LA
Michael S Megaly, M.D., FSCAI1, Brynn Okeson, MS2, Ross Garberich, MS, MBA3, Larissa Stanberry, PhD4, Scott W. Sharkey, M.D.5, Frank V. Aguirre, M.D.6, Mark Tannenbaum, M.D.7, Edward Tannenbaum8, Raviteja Guddeti, MD3, Timothy D. Smith, M.D., FSCAI9, Timothy D. Henry, M.D., MSCAI10 and Santiago Garcia, M.D., FSCAI11, (1)Henry Ford Hospital, Bossier City, LA, (2)Minneapolis Heart Institute, Minneapolis, MN, (3)Minneapolis Heart Institute Foundation, Minneapolis, MN, (4)Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, (5)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (6)-, Springfield, IL, (7)MercyOne Des Moines Medical Center, Des Moines, IA, (8)Columbia University, New York, NY, (9)Sanger Heart & Vascular Institute, Cincinnati, OH, (10)The Christ Hospital Health Network, Covington, KY, (11)The Christ Hospital Health Network, Cincinnati, OH
Keywords: Acute Coronary Syndromes (ACS)
Background:
This study aims to evaluate the incidence and trend of stroke during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) in a contemporary cohort.
Methods
:
The Midwest STEMI consortium is a collaboration of four large regional STEMI programs. We evaluated the incidence and trend of stroke from 2002 to 2019 using Poisson regression analysis. The primary outcomes were the 5-year incidence of death and myocardial infarction (MI). Multivariate regression analysis was used to identify variables independently associated with post-PPCI stroke.
Results
:
6,704 patients had PPCI for STEMI and data available on the occurrence of in-hospital stroke. Stroke occurred in 63 patients (0.93%). The incidence of stroke has not changed since 2002 (1.19% in 2002, 1% in 2019, p-trend=0.778). On multivariate regression analysis, only age (increment of 10) (Odds ratio (OR) 1.37 (95% confidence interval (CI) 1.12-1.67, p-value=0.002) and out-of-hospital cardiac arrest (OR: 2.54 (95% CI 1.29-5.01), p=0.007) were significantly associated with a higher risk of in-hospital stroke after PPCI. Patients who had an in-hospital stroke had a significantly higher risk of in-hospital (17.5%% vs. 5.9%, p<0.001) and 5-year mortality (35% vs. 15%, p<0.001).
Conclusions:
In a large contemporary cohort of patients presenting with STEMI, post-PCI stroke incidence was 1% without significant changes in the last 2 decades. In-hospital stroke was independently associated with a higher risk of short- and long-term mortality.
