Outcomes After Percutaneous Coronary Intervention in Patients With a History of Cerebrovascular Disease
Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium
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Background—Because of shared risk factors between coronary artery disease and cerebrovascular disease, patients with a history of transient ischemic attack (TIA) or stroke are at greater risk of developing coronary artery disease, which may require percutaneous coronary intervention (PCI). However, there remains a paucity of research examining outcomes after PCI in these patients.
Methods and Results—We analyzed consecutive patients who underwent PCI between January 1, 2013, and March 31, 2016, at 47 Michigan hospitals and identified those with a history of TIA/stroke. We used propensity score matching to adjust for differences in baseline characteristics and compared in-hospital outcomes between patients with and without a history of TIA/stroke. We compared rates of 90-day readmission and long-term mortality in a subset of patients. Among 98 730 patients who underwent PCI, 10 915 had a history of TIA/stroke. After matching (n=10 618 per group), a history of TIA/stroke was associated with an increased risk of in-hospital stroke (adjusted odds ratio, 2.04; 95% confidence interval, 1.41–2.96; P<0.001). There were no differences in the risks of other in-hospital outcomes. In a subset of patients with postdischarge data, a history of TIA/stroke was associated with increased risks of 90-day readmission (adjusted odds ratio, 1.22; 95% confidence interval, 1.09–1.38; P<0.001) and long-term mortality (hazard ratio, 1.23; 95% confidence interval, 1.07–1.43; P=0.005).
Conclusions—A history of TIA/stroke was common in patients who underwent PCI and was associated with increased risks of in-hospital stroke, 90-day readmission, and long-term mortality. Given the devastating consequences of post-PCI stroke, patients with a history of TIA/stroke should be counseled on this increased risk before undergoing PCI.
- ischemic attack, transient
- outcome assessment (health care)
- percutaneous coronary intervention
- risk factors
- Received January 10, 2018.
- Accepted April 26, 2018.
- © 2018 American Heart Association, Inc.