Affiliation:
1. Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
2. Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
3. Catheterization and Coronary Intervention Laboratories, Shaare Zedek Medical Center, Jerusalem, Israel
4. Department of Medicine (Cardiology), Hebrew University, Jerusalem, Israel
5. Structural and Congenital Heart Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel
Abstract
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
CVE
s 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
CVE
s with the remaining cohort.
CVE
s 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
CVE
s 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
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
32 articles.
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