Cerebrovascular Events after a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment- Elevation Myocardial Infarction

Eugenia Nikolsky, Roxana Mehran, George D. Dangas, Ke Xu, Rupa Parvataneni, Bernhard Witzenbichler, Giulio Guagliumi, Ran Kornowski, Philippe Généreux, Sorin J. Brener, Gregg W. Stone

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Abstract

Background - 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. Methods and Results - 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 (P<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%; P<0.0001), as well as reinfarction (14.3% versus 3.8%; P=0.0007), ischemia-driven target vessel revascularization (22.8% versus 13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001). Conclusions - 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. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

Original languageEnglish (US)
Article numbere002283
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number4
DOIs
StatePublished - Apr 21 2015
Externally publishedYes

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Stroke
Stents
Ischemia
Myocardial Infarction
ST Elevation Myocardial Infarction
Hemorrhage
Mortality
Transient Ischemic Attack
Anemia
Creatinine
Diabetes Mellitus
Clinical Trials
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Cerebrovascular Events after a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment- Elevation Myocardial Infarction. In: Circulation: Cardiovascular Interventions. 2015 ; Vol. 8, No. 4.
@article{3b24c1a88f8e4adea50f30399d6e7b0a,
title = "Cerebrovascular Events after a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment- Elevation Myocardial Infarction",
abstract = "Background - 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. Methods and Results - 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 (P<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{\%}; P<0.0001), as well as reinfarction (14.3{\%} versus 3.8{\%}; P=0.0007), ischemia-driven target vessel revascularization (22.8{\%} versus 13.0{\%}; P=0.006), and major bleeding (23.5{\%} versus 8.4{\%}; P<0.0001). Conclusions - 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. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.",
author = "Eugenia Nikolsky and Roxana Mehran and Dangas, {George D.} and Ke Xu and Rupa Parvataneni and Bernhard Witzenbichler and Giulio Guagliumi and Ran Kornowski and Philippe G{\'e}n{\'e}reux and Brener, {Sorin J.} and Stone, {Gregg W.}",
year = "2015",
month = "4",
day = "21",
doi = "10.1161/CIRCINTERVENTIONS.114.002283",
language = "English (US)",
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journal = "Circulation: Cardiovascular Interventions",
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}

Nikolsky, E, Mehran, R, Dangas, GD, Xu, K, Parvataneni, R, Witzenbichler, B, Guagliumi, G, Kornowski, R, Généreux, P, Brener, SJ & Stone, GW 2015, 'Cerebrovascular Events after a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment- Elevation Myocardial Infarction', Circulation: Cardiovascular Interventions, vol. 8, no. 4, e002283. https://doi.org/10.1161/CIRCINTERVENTIONS.114.002283

Cerebrovascular Events after a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment- Elevation Myocardial Infarction. / 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.

In: Circulation: Cardiovascular Interventions, Vol. 8, No. 4, e002283, 21.04.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cerebrovascular Events after a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment- Elevation Myocardial Infarction

AU - Nikolsky, Eugenia

AU - Mehran, Roxana

AU - Dangas, George D.

AU - Xu, Ke

AU - Parvataneni, Rupa

AU - Witzenbichler, Bernhard

AU - Guagliumi, Giulio

AU - Kornowski, Ran

AU - Généreux, Philippe

AU - Brener, Sorin J.

AU - Stone, Gregg W.

PY - 2015/4/21

Y1 - 2015/4/21

N2 - Background - 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. Methods and Results - 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 (P<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%; P<0.0001), as well as reinfarction (14.3% versus 3.8%; P=0.0007), ischemia-driven target vessel revascularization (22.8% versus 13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001). Conclusions - 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. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

AB - Background - 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. Methods and Results - 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 (P<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%; P<0.0001), as well as reinfarction (14.3% versus 3.8%; P=0.0007), ischemia-driven target vessel revascularization (22.8% versus 13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001). Conclusions - 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. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

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