Cargando…

Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization

BACKGROUND: One of the most daunting complications of cardiac catheterization is a cerebrovascular event (CVE). We aimed to assess the real‐life incidence, etiology, and risk factors of cardiac catheterization‐related acute CVEs in a large cohort of patients treated in a single center. METHODS AND R...

Descripción completa

Detalles Bibliográficos
Autores principales: Korn‐Lubetzki, Isabelle, Farkash, Rivka, Pachino, Rachel M., Almagor, Yaron, Tzivoni, Dan, Meerkin, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Blackwell Publishing Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886771/
https://www.ncbi.nlm.nih.gov/pubmed/24231658
http://dx.doi.org/10.1161/JAHA.113.000413
_version_ 1782478920839331840
author Korn‐Lubetzki, Isabelle
Farkash, Rivka
Pachino, Rachel M.
Almagor, Yaron
Tzivoni, Dan
Meerkin, David
author_facet Korn‐Lubetzki, Isabelle
Farkash, Rivka
Pachino, Rachel M.
Almagor, Yaron
Tzivoni, Dan
Meerkin, David
author_sort Korn‐Lubetzki, Isabelle
collection PubMed
description BACKGROUND: One of the most daunting complications of cardiac catheterization is a cerebrovascular event (CVE). We aimed to assess the real‐life incidence, etiology, and risk factors of cardiac catheterization‐related acute CVEs in a large cohort of patients treated in a single center. METHODS AND RESULTS: We undertook a retrospective analysis of 43 350 coronary procedures performed on 30 907 procedure days over the period 1992‐2011 and compared patient and procedural characteristics of procedures complicated by CVEs with the remaining cohort. CVEs occurred in 47 cases: 43 were ischemic, 3 intracerebral hemorrhages, and 1 undetermined. The overall CVE rate was 0.15%, with percutaneous coronary intervention (PCI) and diagnostic coronary angiography rates 0.23% and 0.09%, respectively. Using a forward stepwise multivariate logistic regression model including patient demographic and procedural characteristics, a total of 5 significant predictors were defined: prior stroke (OR=15.09, 95% CI [8.11 to 28.08], P<0.0001), presence of coronary arterial thrombus (OR=2.79, 95% CI [1.25 to 6.22], P=0.012), age >75 years (OR=3.33, 95% CI [1.79 to 6.19], P<0.0001), triple vessel disease (OR=2.24, 95% CI [1.20 to 4.18], P=0.011), and performance of intervention (OR=2.21, 95% CI [1.12 to 4.33], P=0.021). An additional analysis excluded any temporal change of CVE rates but demonstrated a significant increase of all high‐risk patient features. CONCLUSION: In a single‐center, retrospective assessment over nearly 20 years, cardiac catheterization‐related CVEs were very rare and nearly exclusively ischemic. The independent predictors for these events were found to be the performance of an intervention and those associated with increased atherosclerotic burden, specifically older age, triple vessel disease, and prior stroke. The presence of intracoronary thrombus appears also to raise the risk of procedure‐related CVE.
format Online
Article
Text
id pubmed-3886771
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Blackwell Publishing Ltd
record_format MEDLINE/PubMed
spelling pubmed-38867712014-01-10 Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization Korn‐Lubetzki, Isabelle Farkash, Rivka Pachino, Rachel M. Almagor, Yaron Tzivoni, Dan Meerkin, David J Am Heart Assoc Original Research BACKGROUND: One of the most daunting complications of cardiac catheterization is a cerebrovascular event (CVE). We aimed to assess the real‐life incidence, etiology, and risk factors of cardiac catheterization‐related acute CVEs in a large cohort of patients treated in a single center. METHODS AND RESULTS: We undertook a retrospective analysis of 43 350 coronary procedures performed on 30 907 procedure days over the period 1992‐2011 and compared patient and procedural characteristics of procedures complicated by CVEs with the remaining cohort. CVEs occurred in 47 cases: 43 were ischemic, 3 intracerebral hemorrhages, and 1 undetermined. The overall CVE rate was 0.15%, with percutaneous coronary intervention (PCI) and diagnostic coronary angiography rates 0.23% and 0.09%, respectively. Using a forward stepwise multivariate logistic regression model including patient demographic and procedural characteristics, a total of 5 significant predictors were defined: prior stroke (OR=15.09, 95% CI [8.11 to 28.08], P<0.0001), presence of coronary arterial thrombus (OR=2.79, 95% CI [1.25 to 6.22], P=0.012), age >75 years (OR=3.33, 95% CI [1.79 to 6.19], P<0.0001), triple vessel disease (OR=2.24, 95% CI [1.20 to 4.18], P=0.011), and performance of intervention (OR=2.21, 95% CI [1.12 to 4.33], P=0.021). An additional analysis excluded any temporal change of CVE rates but demonstrated a significant increase of all high‐risk patient features. CONCLUSION: In a single‐center, retrospective assessment over nearly 20 years, cardiac catheterization‐related CVEs were very rare and nearly exclusively ischemic. The independent predictors for these events were found to be the performance of an intervention and those associated with increased atherosclerotic burden, specifically older age, triple vessel disease, and prior stroke. The presence of intracoronary thrombus appears also to raise the risk of procedure‐related CVE. Blackwell Publishing Ltd 2013-12-19 /pmc/articles/PMC3886771/ /pubmed/24231658 http://dx.doi.org/10.1161/JAHA.113.000413 Text en © 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/3.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Korn‐Lubetzki, Isabelle
Farkash, Rivka
Pachino, Rachel M.
Almagor, Yaron
Tzivoni, Dan
Meerkin, David
Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization
title Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization
title_full Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization
title_fullStr Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization
title_full_unstemmed Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization
title_short Incidence and Risk Factors of Cerebrovascular Events Following Cardiac Catheterization
title_sort incidence and risk factors of cerebrovascular events following cardiac catheterization
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886771/
https://www.ncbi.nlm.nih.gov/pubmed/24231658
http://dx.doi.org/10.1161/JAHA.113.000413
work_keys_str_mv AT kornlubetzkiisabelle incidenceandriskfactorsofcerebrovasculareventsfollowingcardiaccatheterization
AT farkashrivka incidenceandriskfactorsofcerebrovasculareventsfollowingcardiaccatheterization
AT pachinorachelm incidenceandriskfactorsofcerebrovasculareventsfollowingcardiaccatheterization
AT almagoryaron incidenceandriskfactorsofcerebrovasculareventsfollowingcardiaccatheterization
AT tzivonidan incidenceandriskfactorsofcerebrovasculareventsfollowingcardiaccatheterization
AT meerkindavid incidenceandriskfactorsofcerebrovasculareventsfollowingcardiaccatheterization