Treating ACS patients with PCI may increase in-hospital death, stroke risk

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NEW ORLEANS—Using PCI to treat acute coronary syndromes (ACS) may increase the risk of stroke and be associated with high in-hospital mortality, according to registry data presented Sunday at the American Heart Association (AHA) Scientific Sessions.

Atul Aggarwal, MD, an interventional cardiologist from the Nebraska Heart Institute in Hastings, Neb., who presented the findings of Incidence and Predictors of Stroke Association with PCI, said that the “strong association of ACS with stroke developing in association with PCI is noteworthy and has not been described previously.”

For patients undergoing PCI, Aggarwal said that “stroke appears to be more common in older patients, those with known cardiovascular disease, patients with ACS and those requiring hemodynamic support with an intra-aortic balloon pump.”

The researchers applied data from the National Cardiovascular Data Registry from Jan. 1, 2004 to March 31, 2007. The study found that the incidence of stroke was 0.22 percent among 706,782 patients undergoing percutaneous coronary revascularization.

Aggarwal reported that variables with the strongest statistical association for developing stroke in multivariate analysis are known cerebrovascular disease, older age, STEMI, unstable angina and intra-aortic balloon pump use.

He said that in-hospital mortality was approximately 30 percent higher in patients who developed a stroke compared with those who did not develop peri-procedural stroke. The results showed that the rates of peri-procedural MI, cardiogenic shock, congestive heart failure, renal failure and bleeding complications were also significantly greater among patients who had previously experienced a stroke.

Aggarwal acknowledged the study’s limitation was the absence of data from imaging studies, which would have allowed for the stroke classification. While stroke following PCI is rare, he said that further study is required to understand the mechanisms of peri-procedural stroke during PCI to propose improved strategies for diagnosis and treatment.