Chun Shing Kwok1, Evangelos Kontopantelis2, Phyo K Myint3, Azfar Zaman4, Colin Berry5, Bernard Keavney1, Jim Nolan6, Peter F Ludman7, Mark A de Belder8, Iain Buchan2, Mamas A Mamas9. 1. Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK. 2. Farr Institute, Institute of Population Health, University of Manchester, Manchester, UK. 3. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. 4. Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK. 5. Royal Jubilee Hospital, Glasgow, UK. 6. University Hospital of North Staffordshire, Stoke-on-Trent, UK. 7. Queen Elizabeth Hospital, Edgbaston, Birmingham, UK. 8. The James Cook University Hospital, Middlesbrough, UK. 9. Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK Farr Institute, Institute of Population Health, University of Manchester, Manchester, UK Keele Cardiac Research Group, Institutes of Science and Technology in Medicine and Primary Care, Keele University, Stoke-on-Trent, UK mamasmamas1@yahoo.co.uk.
Abstract
AIMS: This study aims to evaluate temporal changes in stroke complications and their association with mortality and MACE outcomes in a national cohort of patients undergoing percutaneous coronary interventions (PCIs) in England and Wales. METHODS AND RESULTS: A total of 426 046 patients who underwent PCI in England and Wales between 2007 and 2012 in the British Cardiovascular Intervention Society (BCIS) database were analysed. Statistical analyses were performed evaluating the rates of stroke complications according to the year of PCI and multiple logistic regressions were used to evaluate the odds of 30-day mortality and in-hospital major adverse cardiovascular events (MACE; a composite of in-hospital mortality, myocardial infarction or re-infarction, and revascularization) with stroke complications. Four hundred and thirty-six patients (0.1%) sustained an ischaemic stroke/TIA complication and 107 patients (0.03%) sustained a haemorrhagic stroke complication. Ischaemic stroke/TIA complications increased non-linearly from 0.67 (95% CI 0.47-0.87) to 1.14 (0.94-1.34) per 1000 patients between 2007 and 2012 (P = 0.006), whilst haemorrhagic stroke rates decreased non-linearly from 0.29 (0.19-0.39) to 0.15 (0.05-0.25) per 1000 patients in 2012 (P = 0.009). Following adjustment for baseline clinical and procedural demographics, ischaemic stroke was independently associated with both 30-day mortality (OR 4.92, 3.06-7.92) and in-hospital MACE (OR 3.11, 1.83-5.27). An even greater impact on prognosis was observed with haemorrhagic complications (30-day mortality: OR 13.87, 6.37-30.21), in-hospital MACE (OR 13.50, 6.30-28.92). CONCLUSIONS: Incident ischaemic stroke complications have increased over time, whilst haemorrhagic stroke complications have decreased, driven through changes in clinical, procedural, drug-treatment, and demographic factors. Both ischaemic and haemorrhagic strokes are rare but devastating complications with high 30-day mortality and in-hospital MACE rates. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: This study aims to evaluate temporal changes in stroke complications and their association with mortality and MACE outcomes in a national cohort of patients undergoing percutaneous coronary interventions (PCIs) in England and Wales. METHODS AND RESULTS: A total of 426 046 patients who underwent PCI in England and Wales between 2007 and 2012 in the British Cardiovascular Intervention Society (BCIS) database were analysed. Statistical analyses were performed evaluating the rates of stroke complications according to the year of PCI and multiple logistic regressions were used to evaluate the odds of 30-day mortality and in-hospital major adverse cardiovascular events (MACE; a composite of in-hospital mortality, myocardial infarction or re-infarction, and revascularization) with stroke complications. Four hundred and thirty-six patients (0.1%) sustained an ischaemic stroke/TIA complication and 107 patients (0.03%) sustained a haemorrhagic stroke complication. Ischaemic stroke/TIA complications increased non-linearly from 0.67 (95% CI 0.47-0.87) to 1.14 (0.94-1.34) per 1000 patients between 2007 and 2012 (P = 0.006), whilst haemorrhagic stroke rates decreased non-linearly from 0.29 (0.19-0.39) to 0.15 (0.05-0.25) per 1000 patients in 2012 (P = 0.009). Following adjustment for baseline clinical and procedural demographics, ischaemic stroke was independently associated with both 30-day mortality (OR 4.92, 3.06-7.92) and in-hospital MACE (OR 3.11, 1.83-5.27). An even greater impact on prognosis was observed with haemorrhagic complications (30-day mortality: OR 13.87, 6.37-30.21), in-hospital MACE (OR 13.50, 6.30-28.92). CONCLUSIONS: Incident ischaemic stroke complications have increased over time, whilst haemorrhagic stroke complications have decreased, driven through changes in clinical, procedural, drug-treatment, and demographic factors. Both ischaemic and haemorrhagic strokes are rare but devastating complications with high 30-day mortality and in-hospital MACE rates. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Mario Gaudino; Dominick J Angiolillo; Antonino Di Franco; Davide Capodanno; Faisal Bakaeen; Michael E Farkouh; Stephen E Fremes; David Holmes; Leonard N Girardi; Sunao Nakamura; Stuart J Head; Seung-Jung Park; Michael Mack; Patrick W Serruys; Marc Ruel; Gregg W Stone; Derrick Y Tam; Michael Vallely; David P Taggart Journal: J Am Heart Assoc Date: 2019-06-27 Impact factor: 5.501
Authors: Paraskevi Taxiarchi; Evangelos Kontopantelis; Tim Kinnaird; Nick Curzen; Adrian Banning; Peter Ludman; Ahmad Shoaib; Muhammad Rashid; Glen P Martin; Mamas A Mamas Journal: Int J Cardiol Date: 2020-07-30 Impact factor: 4.164