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Multicenter Study
. 2014 Jul 15;114(2):206-13.
doi: 10.1016/j.amjcard.2014.04.044. Epub 2014 May 6.

Temporal trends in percutaneous coronary intervention--associated acute cerebrovascular accident (from the 1998 to 2008 Nationwide Inpatient Sample Database)

Anupama Shivaraju  1 , Changhong Yu  2 , Michael W Kattan  2 , Hui Xie  3 , Adhir R Shroff  1 , Mladen I Vidovich  4
Affiliations
Multicenter Study

Temporal trends in percutaneous coronary intervention--associated acute cerebrovascular accident (from the 1998 to 2008 Nationwide Inpatient Sample Database)

Anupama Shivaraju et al. Am J Cardiol. .

Abstract

Acute cerebrovascular accident (CVA) after percutaneous coronary intervention (PCI) for acute coronary syndrome and coronary artery disease is associated with high rates of morbidity and mortality. Nationwide Inpatient Sample from 1998 to 2008 was used to identify 1,552,602 PCIs performed for acute coronary syndrome and coronary artery disease. We assessed temporal trends in the incidence, predictors, and prognostic impact of CVA in a broad range of patients undergoing PCI. The overall incidence of CVA was 0.56% (95% confidence interval [CI] 0.55 to 0.57). The incidence of CVA remained unchanged over the study period (adjusted p for trend=0.2271). The overall mortality rate in the CVA group was 10.76% (95% CI 10.1 to 11.4). The adjusted odds ratio (OR) of CVA for in-hospital mortality was 7.74 (95% CI 7.00 to 8.57, p<0.0001); this remained high but decreased over the study period (adjusted p for trend<0.0001). Independent predictors of CVA included older age (OR 1.03, 95% CI 1.02 to 1.03, p<0.0001), disorder of lipid metabolism (OR 1.31, 95% CI 1.24 to 1.38, p<0.001), history of tobacco use (OR 1.21, 95% CI 1.10 to 1.34, p=0.0002), coronary atherosclerosis (OR 1.56, 95% CI 1.43 to 1.71, p<0.0001), and intra-aortic balloon pump use (OR 1.39, 95% CI 1.09 to 1.77, p=0.0073). A nomogram for predicting the probability of CVA achieved a concordance index of 0.73 and was well calibrated. In conclusion, the incidence of CVA associated with PCI has remained unchanged from 1998 to 2008 in face of improved equipment, techniques, and adjunctive pharmacology. The risk of CVA-associated in-hospital mortality is high; however, this risk has decreased over the study period.

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Figures

Figure 1
Figure 1
Incidence of cerebrovascular accidents from 1998 to 2008.
Figure 2
Figure 2
Independent predictors for cerebrovascular accidents after adjusting for covariates.
Figure 3
Figure 3
A Incidence of in-hospital mortality with cerebrovascular accidents from 1998 to 2008. B Incidence of in-hospital mortality without cerebrovascular accidents from 1998 to 2008.
Figure 3
Figure 3
A Incidence of in-hospital mortality with cerebrovascular accidents from 1998 to 2008. B Incidence of in-hospital mortality without cerebrovascular accidents from 1998 to 2008.
Figure 4
Figure 4
A Nomogram for predicting the likelihood of cerebrovascular accidents using patient demographic and clinical characteristic variables. B Calibration curve demonstrating the agreement between the observed and the predicted outcome.
Figure 4
Figure 4
A Nomogram for predicting the likelihood of cerebrovascular accidents using patient demographic and clinical characteristic variables. B Calibration curve demonstrating the agreement between the observed and the predicted outcome.
See this image and copyright information in PMC

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