Complicaciones cerebrovasculares luego de angiografía coronaria en contexto de infarto agudo de miocardio. Estudio de cohorte

Abstract

Introduction: cerebrovascular events are serious but infrequent complications of invasive percutaneous coronary procedure.Coronary angioplasty increases the risk 17 times. Patients suffering this complication have higher morbidity and mortality rates.Objective: to determine the clinical and evolutionary characteristics of the patients who developed a cerebrovascular event after an emergency coronary angiography in the context of an acute myocardial infarction. Secondly, analyze thetemporal relationship between both events and identify previous factors associated with the development of neurological complications.Method: demographic, characteristics of the angiographic procedure, and cerebrovascular features of a population of patients with stroke occurring within 30 days after of invasive percutaneous coronary procedure for myocardial infarctions are described. Data was retrospectively collected from the Cardiovascular University Center (Hospital de Clinicas, Montevideo, Uruguay) between 2008-2017.Results: 24 patients, 54.2% were men; 1/3 had prior stroke; 66.7% presented non ST segment elevation myocardial infarction.All of the cerebrovascular events were ischemic, most were from the anterior circulation. 62% occurred in the first 48 hours after invasive percutaneous coronary procedure, having this group a higher percentage of percutaneous coronary angioplasty and longer procedures. In three patients recombinant tissue plasminogen activator was used for stroke treatment. NIHSS median was 4 points (IQ 2-8) in patients without ST-segment elevation myocardial infarction and 8 points (IQ 3-20) in patients with ST-segment elevation myocardial infarction (p=0.20). 79% of patients had complications during the hospitalization, and 5 died.Conclusions: there was a similar proportion of men and women, and a high percentage of patients with a history of stroke. The presentation of the cardiovascular events was predominantly non ST myocardial infarction. All the cerebrovascular events were ischemic, it occurred for most patients in the first 48 hours after invasive percutaneous coronary procedure, and the anterior brain circulation was most commonly affected. Stroke/transient ischemic attack after invasive percutaneous coronary procedure could be associated with longer hospital stays and death.