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Stroke after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: timing, characteristics, and clinical outcomes.

Publication ,  Journal Article
Guptill, JT; Mehta, RH; Armstrong, PW; Horton, J; Laskowitz, D; James, S; Granger, CB; Lopes, RD
Published in: Circ Cardiovasc Interv
April 2013

BACKGROUND: Stroke is a rare but potentially devastating complication of acute myocardial infarction. Little is known about stroke timing, characteristics, and clinical outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: We studied 5372 patients enrolled in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. We analyzed stroke incidence, type, timing, and association with the prespecified 90-day clinical outcomes. Cox proportional hazards modeling was performed to assess the relationship between stroke and outcomes, after adjusting baseline characteristics and analyzing stroke as a time-dependent covariate. Stroke occurred in 69 primary patients with PCI (1.3%). A third of strokes were ischemic (n=23; 33%), 12% (n=8) were hemorrhagic, and the remaining 55% (n=38) were of uncertain type. The median (25th, 75th percentile) time of stroke occurrence was 6 (3, 14) days. Overall, 43% of strokes occurred within 48 hours of PCI, and all hemorrhagic strokes occurred within 48 hours. Stroke was associated with an increased risk of 90-day death (unadjusted hazard ratio [HR], 8.0; 95% confidence interval [CI], 4.8-13.5), congestive heart failure (unadjusted HR, 3.2; 95% CI, 1.3-7.8), and 30-day hospital readmission (unadjusted HR, 3.2; 95% CI, 2.0-5.1). After adjustment, stroke was still strongly associated with 90-day death (adjusted HR, 5.6; 95% CI, 3.2-9.8) and the combination end point of death, congestive heart failure, or cardiogenic shock at 90 days (adjusted HR, 2.4; 95% CI, 1.2-4.7). CONCLUSIONS: Stroke is an infrequent complication in the setting of ST-segment elevation myocardial infarction treated with primary PCI but is associated with increased morbidity and mortality. Studies to determine mechanisms that may be responsible for strokes that occur >48 hours from primary PCI are warranted. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00091637.

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

April 2013

Volume

6

Issue

2

Start / End Page

176 / 183

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Stroke
  • Single-Chain Antibodies
  • Proportional Hazards Models
  • Patient Readmission
  • Myocardial Infarction
  • Morbidity
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Guptill, J. T., Mehta, R. H., Armstrong, P. W., Horton, J., Laskowitz, D., James, S., … Lopes, R. D. (2013). Stroke after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: timing, characteristics, and clinical outcomes. Circ Cardiovasc Interv, 6(2), 176–183. https://doi.org/10.1161/CIRCINTERVENTIONS.112.000159
Guptill, Jeffrey T., Rajendra H. Mehta, Paul W. Armstrong, John Horton, Daniel Laskowitz, Stefan James, Christopher B. Granger, and Renato D. Lopes. “Stroke after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: timing, characteristics, and clinical outcomes.Circ Cardiovasc Interv 6, no. 2 (April 2013): 176–83. https://doi.org/10.1161/CIRCINTERVENTIONS.112.000159.
Guptill JT, Mehta RH, Armstrong PW, Horton J, Laskowitz D, James S, et al. Stroke after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: timing, characteristics, and clinical outcomes. Circ Cardiovasc Interv. 2013 Apr;6(2):176–83.
Guptill, Jeffrey T., et al. “Stroke after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: timing, characteristics, and clinical outcomes.Circ Cardiovasc Interv, vol. 6, no. 2, Apr. 2013, pp. 176–83. Pubmed, doi:10.1161/CIRCINTERVENTIONS.112.000159.
Guptill JT, Mehta RH, Armstrong PW, Horton J, Laskowitz D, James S, Granger CB, Lopes RD. Stroke after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: timing, characteristics, and clinical outcomes. Circ Cardiovasc Interv. 2013 Apr;6(2):176–183.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

April 2013

Volume

6

Issue

2

Start / End Page

176 / 183

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Stroke
  • Single-Chain Antibodies
  • Proportional Hazards Models
  • Patient Readmission
  • Myocardial Infarction
  • Morbidity
  • Middle Aged
  • Male