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Title: | Incidence and risk factors for stroke following percutaneous coronary intervention. | Authors: | Chan W.;Andrianopoulos N.;Thrift A.G. ;Clark D.J.;Brennan A.L.;Freeman M.;O'Brien J.;Sebastian M.;Shaw J.A.;Duffy S.J.;Reid C.M.;Dinh D.;Dawson L.P.;Cole J.A.;Lancefield T.F.;Ajani A.E. | Institution: | (Dawson, Cole, O'Brien, Chan, Shaw, Duffy) Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (Dawson, Ajani) Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (Cole, Chan, Duffy) Baker IDI Heart and Diabetes Institute, Melbourne, Australia (Lancefield, Clark) Department of Cardiology, Austin Health, Melbourne, Australia (Andrianopoulos, Brennan, Dinh, Reid, Duffy) Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (Thrift) Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia (Freeman) Department of Cardiology, Box Hill Hospital, Melbourne, Australia (Sebastian) Department of Cardiology, University Hospital Geelong, Geelong, Australia (Reid) School of Public Health, Curtin University, Perth, Australia | Issue Date: | 17-Dec-2020 | Copyright year: | 2020 | Publisher: | SAGE Publications Inc. | Place of publication: | United Kingdom | Publication information: | International Journal of Stroke. 15 (8) (pp 909-922), 2020. Date of Publication: 01 Oct 2020. | Journal: | International Journal of Stroke | Abstract: | Background: Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population. Aim(s): This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls. Method(s): Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005-2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997-1999) and predefined variables assessed for association with inpatient or outpatient stroke. Result(s): Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes (p < 0.0001) and mortality (p < 0.0001), as well as 12-month mortality (p < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30-45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients >=65 years old. Conclusion(s): Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the general population, outpatient stroke rates following percutaneous coronary intervention are higher for younger, but not older, patients.Copyright © 2020 World Stroke Organization. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1177/1747493020912607 | PubMed URL: | 32248767 [http://www.ncbi.nlm.nih.gov/pubmed/?term=32248767] | ISSN: | 1747-4930 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/29029 | Type: | Article | Subjects: | out of hospital cardiac arrest *percutaneous coronary intervention priority journal rheumatoid arthritis severe renal impairment sex difference smoking ST segment elevation myocardial infarction/th [Therapy] very elderly acetylsalicylic acid anticoagulant agent antithrombocytic agent bivalirudin fibrinogen receptor antagonist heparin inotropic agent/iv [Intravenous Drug Administration] insulin/dt [Drug Therapy] low molecular weight heparin purinergic P2Y receptor antagonist warfarin intraaortic balloon pump thrombectomy device heart infarction/co [Complication] adult age aged all cause mortality article atrial fibrillation Australian bleeding/co [Complication] bleeding/th [Therapy] body mass brain hemorrhage brain ischemia cardiogenic shock/co [Complication] cardiovascular disease/co [Complication] *cerebrovascular accident chronic lung disease comorbidity controlled study diabetes mellitus/dt [Drug Therapy] dyslipidemia female heart left ventricle ejection fraction hospital mortality human major clinical study male middle aged moderate renal impairment brain ischemia cardiogenic shock / complication cardiovascular disease / complication *cerebrovascular accident chronic lung disease comorbidity controlled study diabetes mellitus / drug therapy dyslipidemia female heart infarction / complication heart left ventricle ejection fraction hospital mortality human major clinical study male middle aged moderate renal impairment out of hospital cardiac arrest *percutaneous coronary intervention priority journal rheumatoid arthritis adult sex difference smoking ST segment elevation myocardial infarction / therapy very elderly severe renal impairment age aged all cause mortality Article atrial fibrillation Australian bleeding / complication / therapy body mass brain hemorrhage |
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