Cerebrovascular Events After a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment– Elevation Myocardial Infarction. (April 2015)

• Record Type: Journal Article
• Authors: Nikolsky, Eugenia; Mehran, Roxana; Dangas, George D.; Xu, Ke; Parvataneni, Rupa; Witzenbichler, Bernhard; Guagliumi, Giulio; Kornowski, Ran; Généreux, Philippe; Brener, Sorin J.; Stone, Gregg W.
• Is Part Of: Circulation. Volume 8:Number 4(2015)
• Publication Date: 2015-04
• Subjects: Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.114.002283
• Languages: English
• ISSNs: 1941-7640

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>Patients with ST-segment–elevation myocardial infarction are at increased risk of cerebrovascular events. We assessed the incidence, predictors, and implications of cerebrovascular events in patients with ST-segment–elevation myocardial infarction managed with a primary percutaneous coronary intervention strategy.</p> </sec> <sec> <title>Methods and Results—</title> <p>In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, 72 of 3602 patients (2.0%) experienced at least 1 cerebrovascular event (stroke: 63 patients; transient ischemic attack: 12 patients) during the 3-year follow-up (40.3% within 30 days, 20.8% between 30 days and 1 year, and 38.9% between 1 and 3 years). Stroke was ischemic in 58 (92.1%) patients and hemorrhagic in 5 (7.9%) patients. More than half of all strokes (52.3%) were disabling. By principal management strategy, cerebrovascular events developed in 2.0%, 14.9%, and 1.9% of patients triaged to primary percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy, respectively (<italic>P</italic><0.0001). Cerebrovascular events were independently predicted by older age, creatinine clearance <60 mL/min, treatment with coronary artery bypass grafting, anemia, and diabetes mellitus. Cerebrovascular events were associated with significantly increased rates of 3-year mortality (20.5% versus 6.5%; <italic>P</italic><0.0001), as well as reinfarction (14.3% versus 3.8%; <italic>P</italic>=0.0007), ischemia-driven target vessel revascularization (22.8% versus 13.0%; <italic>P</italic>=0.006), and major bleeding (23.5% versus 8.4%; <italic>P</italic><0.0001).</p> </sec> <sec> <title>Conclusions—</title> <p>In HORIZONS-AMI, cerebrovascular events within 3 years after ST-segment–elevation myocardial infarction in patients undergoing a primary percutaneous coronary intervention management strategy occurred in 2.0% of patients and were most frequent after coronary artery bypass grafting. Cerebrovascular events were often disabling and were strongly associated with high rates of death, reinfarction, recurrent ischemia, and major bleeding.</p> </sec> <sec> <title>Clinical Trial Registration—</title> <p>URL: <ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.clinicaltrials.gov</ext-link>. Unique identifier: NCT00433966.</p> </sec> </abstract>