Abstract
Both hemorrhagic and ischemic cerebrovascular events are rare but serious complications after acute myocardial infarction (MI) and coronary angiography/percutaneous coronary intervention (PCI). The most threatening one is intracranial hemorrhage related to antiplatelet and antithrombotic treatment of acute MI. In up to 10% of patients with acute MI ischemic stroke can result from embolisation of intraventricular or intraatrial thrombi [ [1] Kleczynski P. Dziewierz A. Rakowski T. et al. Cardioembolic acute myocardial infarction and stroke in a patient with persistent atrial fibrillation. Int. J. Cardiol. 2012; 161: e46-e47 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar ]. It may occur within the first 2 weeks, but also as early as in the first 24 h. On the contrary, ischemic stroke observed during or early after coronary angiography/PCI is frequently iatrogenic and may be caused by embolisation of atherosclerotic or thrombotic material from the ascending aorta, carotid artery dissection, or air embolism [ 2 Hamon M. Baron J.C. Viader F. Hamon M. Periprocedural stroke and cardiac catheterization. Circulation. 2008; 118: 678-683 Crossref PubMed Scopus (82) Google Scholar , 3 Cohen M.G. Ohman E.M. Should the benefit of transradial access still be questioned?. JACC. Cardiovasc. Interv. 2016; 9: 908-910 Crossref PubMed Scopus (4) Google Scholar ]. There are some ambiguous data from observational and randomized studies on the higher rate of stroke associated with the radial access [ 3 Cohen M.G. Ohman E.M. Should the benefit of transradial access still be questioned?. JACC. Cardiovasc. Interv. 2016; 9: 908-910 Crossref PubMed Scopus (4) Google Scholar , 5 Patel V.G. Brayton K.M. Kumbhani D.J. Banerjee S. Brilakis E.S. Meta-analysis of stroke after transradial versus transfemoral artery catheterization. Int. J. Cardiol. 2013; 168: 5234-5238 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ]. In addition, an increased risk of stroke was suggested for primary PCI with the use of thrombectomy devices [ 4 Kwok C.S. Kontopantelis E. Myint P.K. et al. Stroke following percutaneous coronary intervention: type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007–12. Eur. Heart J. 2015; 36: 1618-1628 Crossref PubMed Scopus (61) Google Scholar , 6 Jolly S.S. Cairns J.A. Yusuf S. et al. Stroke in the TOTAL trial: a randomized trial of routine thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction. Eur. Heart J. 2015; 36: 2364-2372 Crossref PubMed Scopus (82) Google Scholar , 7 Barkagan M. Steinvil A. Berchenko Y. et al. Impact of routine manual aspiration thrombectomy on outcomes of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction: a meta-analysis. Int. J. Cardiol. 2016; 204: 189-195 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar ]. However, these findings were not confirmed by other studies. Thus, we sought to identify the predictors of periprocedural stroke in a large, unselected cohort of patients presenting with acute MI enrolled in the Polish National Registry of PCI (ORPKI) from 2014 to 2015.
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