The Journal of invasive cardiology · 2025
Clinical, procedural, and follow-up outcomes of percutaneous coronary intervention-related stroke: insight from the PROGRESS-COMPLICATIONS registry.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ser Ozgur Selim, Mutlu Deniz, Strepkos Dimitrios, Carvalho Pedro E, Alexandrou Michaella, Kladou Eleni, Mastrodemos Olga, Moscardelli Silvia, Ng Primero, Rangan Bavana V, Sara Jas D, Jalli Sandeep, Voudris Konstantinos, Azzalini Lorenzo, Sandoval Yader, Burke M Nicholas, Brilakis Emmanouil S
Аннотация
BACKGROUND: Stroke is an infrequent but potentially severe complication of percutaneous coronary intervention (PCI).
METHODS: The authors describe the clinical features, angiographic characteristics, and procedural and follow-up outcomes of PCI-related stroke in the PROGRESS-COMPLICATIONS registry.
RESULTS: Of 22 503 patients who underwent PCI at 2 tertiary care centers between 2016 and 2023, 157 (0.7%) had PCI-related stroke: 10 (6.4%) had hemorrhagic stroke while 147 (93.6%) had ischemic stroke. The mean age of the stroke patients was 70 ± 11 years; 63.1% were men, 25.2% had prior heart failure, 71.0% had diabetes mellitus, 85.4% had hypertension, and 36.6% had chronic kidney disease. Radial access was used in 39.5% of the patients; 31.1% of stroke patients presented with ST-segment elevation myocardial infarction (STEMI), 49.7% with non-STEMI, and 14.6% with stable angina. The target lesions were complex: 47.1% were bifurcations, 63.7% had moderate to severe calcification, and 56.0% had thrombus. The mean minimum activated clotting time of the stroke patients was 214 (165, 245) seconds. Technical success was 93%. A mechanical circulatory support device was utilized in 31 (20%) of the patients, and 17 (10.8%) presented with cardiogenic shock. Hypotension during the procedure occurred in 36 patients (22.9%), bleeding occurred in 37 (23.6), and in-hospital mortality was 13.7%. During a median follow-up of 32 months, 48.3% of the patients had follow-up major adverse cardiovascular events (MACE) and 24.5% died.
CONCLUSIONS: Stroke is an infrequent but severe complication of PCI, associated with high mortality and MACE. Most periprocedural strokes were ischemic.
METHODS: The authors describe the clinical features, angiographic characteristics, and procedural and follow-up outcomes of PCI-related stroke in the PROGRESS-COMPLICATIONS registry.
RESULTS: Of 22 503 patients who underwent PCI at 2 tertiary care centers between 2016 and 2023, 157 (0.7%) had PCI-related stroke: 10 (6.4%) had hemorrhagic stroke while 147 (93.6%) had ischemic stroke. The mean age of the stroke patients was 70 ± 11 years; 63.1% were men, 25.2% had prior heart failure, 71.0% had diabetes mellitus, 85.4% had hypertension, and 36.6% had chronic kidney disease. Radial access was used in 39.5% of the patients; 31.1% of stroke patients presented with ST-segment elevation myocardial infarction (STEMI), 49.7% with non-STEMI, and 14.6% with stable angina. The target lesions were complex: 47.1% were bifurcations, 63.7% had moderate to severe calcification, and 56.0% had thrombus. The mean minimum activated clotting time of the stroke patients was 214 (165, 245) seconds. Technical success was 93%. A mechanical circulatory support device was utilized in 31 (20%) of the patients, and 17 (10.8%) presented with cardiogenic shock. Hypotension during the procedure occurred in 36 patients (22.9%), bleeding occurred in 37 (23.6), and in-hospital mortality was 13.7%. During a median follow-up of 32 months, 48.3% of the patients had follow-up major adverse cardiovascular events (MACE) and 24.5% died.
CONCLUSIONS: Stroke is an infrequent but severe complication of PCI, associated with high mortality and MACE. Most periprocedural strokes were ischemic.