Abstract 15135: Timing of Percutaneous Coronary Intervention and Risk of New-Onset Acute Ischemic Stroke in Non-ST Elevation Myocardial Infarction: An Insight of National Inpatient Sample 2016-2019

Abstract

Introduction: Current guidelines recommend an early invasive strategy within 24 hours only in high-risk non-ST elevation myocardial infarction (NSTEMI). New-onset acute ischemic stroke (NAIS) is a rare but fatal complication of percutaneous coronary intervention (PCI). However, the effect of the timing of the PCI and the risk of NAIS in NSTEMI is not well defined. Hypothesis: Late PCI is associated with NAIS risk in NSTEMI. Methods: NSTEMI patients who underwent PCI were queried from the National Inpatient Sample Database (2016-2019) and stratified into three groups: early (<24 h), medium (24-72 h), and late PCI (>72 h). Multivariable logistic regression models were used to determine the timing of PCI and NAIS, adjusted for demographics, comorbidities, and hospital characteristics. Results: Among 633,115 weighted hospitalizations in 2016-2019, late PCI patients had a higher incidence of NAIS (1.3%) compared to early (0.67%) and medium PCI (0.71%). Late PCI patients were older, more likely to be female, and had a higher prevalence of comorbidities (diabetes mellitus, congestive heart failure, chronic pulmonary and renal disease, and atrial fibrillation) than early and medium PCI. After adjustment, only late PCI was significantly associated with a 55% increased NAIS risk (adjusted OR: 1.55 [95% CI: 1.30-1.84]). There was heterogeneity in the magnitude of risk by age and gender. Younger people (<65 years) ( p for interaction <0.0001) and males (interaction -value p =0.0433) were more likely to encounter NAIS. The incidence of NAIS increased from 2016 to 2019 in both medium and late PCI. Conclusions: Late PCI over 72 hours was associated with a higher risk of NAIS than PCI performed within 24 hours, particularly among young and male people.