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Safety of percutaneous coronary intervention in patients with acute ischemic stroke/transient ischemic attack and acute coronary syndrome

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Abstract

Background

Cardiac events in patients with acute stroke are frequent. Urgent PCI in myocardial infarction is crucial to improve outcome. However, the situation is complex as intracranial hemorrhage is a frequent complication of stroke but antithrombotic medication is indispensable during and after PCI. Therefore in this study, we aimed to investigate the safety of percutaneous coronary intervention (PCI) in patients hospitalized with acute ischemic stroke and concomitant acute coronary syndrome (ACS).

Methods and results

In a single-center, case-series study we investigated 80 patients hospitalized with acute stroke/transient ischemic attack (TIA) and concomitant ACS undergoing coronary angiography. Patients with subsequent PCI were compared to patients with medical treatment alone. The primary end point was the composite of death, recurrent MI, coronary re-intervention, recurrent stroke or bleeding during 1-year follow-up. The secondary end point consisted of the components of the primary end point. Age, gender and cardiovascular risk factors did not differ between groups. However, severity of initial stroke and coronary artery disease was higher in the PCI group. Accordingly, antiplatelet medication with aspirin and clopidogrel was prescribed more frequently in the PCI group. Nevertheless, during 1-year follow-up, the primary end point did not differ between groups [38 vs. 50 %, odds ratio (OR) 1.7, CI 0.69–4.07, P = 0.23]. Intracranial hemorrhage was even numerically lower in patients undergoing PCI (5 vs. 3 %, OR 0.4, CI 0.04–5.6, P = 0.46).

Conclusions

The primary and secondary end points were not enhanced in patients undergoing PCI. Therefore PCI is safe in patients with stroke/TIA and concomitant ACS.

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References

  1. Kumar S, Selim MH, Caplan LR (2010) Medical complications after stroke. Lancet Neurol 9:105–118 [Epub 2010/01/20]

    Article  PubMed  Google Scholar 

  2. Prosser J, MacGregor L, Lees KR, Diener HC, Hacke W, Davis S (2007) Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke 38:2295–2302 [Epub 2007/06/16]

    Article  PubMed  Google Scholar 

  3. Liao J, O’Donnell MJ, Silver FL, Thiruchelvam D, Saposnik G, Fang J, Gould L, Mohamed N, Kapral MK (2009) In-hospital myocardial infarction following acute ischaemic stroke: an observational study. Eur J Neurol 16:1035–1040 [Epub 2009/07/21]

    Article  CAS  PubMed  Google Scholar 

  4. Liosis S, Bauer T, Schiele R, Gohlke H, Gottwik M, Katus H, Sabin G, Zahn R, Schneider S, Rauch B, Senges J, Zeymer U (2013) Predictors of 1-year mortality in patients with contemporary guideline-adherent therapy after acute myocardial infarction: results from the OMEGA study. Clin Res Cardiol 102:671–677 [Epub 2013/06/07]

    Article  CAS  PubMed  Google Scholar 

  5. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG et al (2014) ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014(35):2541–2619 [Epub 2014/09/01]

    Google Scholar 

  6. Mullins ME, Lev MH, Schellingerhout D, Gonzalez RG, Schaefer PW (2005) Intracranial hemorrhage complicating acute stroke: how common is hemorrhagic stroke on initial head CT scan and how often is initial clinical diagnosis of acute stroke eventually confirmed? AJNR Am J Neuroradiol 26:2207–2212 [Epub 2005/10/13]

    PubMed  Google Scholar 

  7. Zusman O, Amit G, Gilutz H, Zahger D (2012) The significance of new onset atrial fibrillation complicating acute myocardial infarction. Clin Res Cardiol 101:17–22 [Epub 2011/09/13]

    Article  PubMed  Google Scholar 

  8. Nielsen PB, Lane DA, Rasmussen LH, Lip GY, Larsen TB (2015) Renal function and non-vitamin K oral anticoagulants in comparison with warfarin on safety and efficacy outcomes in atrial fibrillation patients: a systemic review and meta-regression analysis. Clin Res Cardiol 104:418–429 [Epub 2014/11/25]

    Article  CAS  PubMed  Google Scholar 

  9. Nuhrich JM, Kuck KH, Andresen D, Steven D, Spitzer SG, Hoffmann E, Schumacher B, Eckardt L, Brachmann J, Lewalter T, Hochadel M, Senges J, Willems S, Hoffmann BA (2015) Oral anticoagulation is frequently discontinued after ablation of paroxysmal atrial fibrillation despite previous stroke: data from the German Ablation Registry. Clin Res Cardiol 104:463–470 [Epub 2014/12/30]

    Article  PubMed  Google Scholar 

  10. Frontera A, Wilson DG, Sekhon H, Duncan ER, Thomas G (2015) Atrial fibrillation and hypertrophic cardiomyopathy: who to anticoagulate? Clin Res Cardiol [Epub 2015/07/03]

  11. Schroeter MR, Danner BC, Hunlich M, Schillinger W (2014) Uncommon delayed and late complications after percutaneous left atrial appendage closure with Amplatzer((R)) Cardiac Plug. Clin Res Cardiol 103:285–290 [Epub 2013/12/07]

    Article  PubMed  Google Scholar 

  12. Ferner M, Wachtlin D, Konrad T, Deuster O, Meinertz T, von Bardeleben S, Munzel T, Seibert-Grafe M, Breithardt G, Rostock T (2015) Rationale and design of the RE-LATED AF-AFNET 7 trial: REsolution of Left atrial-Appendage Thrombus-Effects of Dabigatran in patients with Atrial Fibrillation. Clin Res Cardiol [Epub 2015/06/26]

  13. Seeger J, Bothner C, Dahme T, Gonska B, Scharnbeck D, Markovic S, Rottbauer W, Wohrle J (2015) Efficacy and safety of percutaneous left atrial appendage closure to prevent thromboembolic events in atrial fibrillation patients with high stroke and bleeding risk. Clin Res Cardiol [Epub 2015/09/01]

  14. Gloekler S, Shakir S, Doblies J, Khattab AA, Praz F, Guerios E, Koermendy D, Stortecky S, Pilgrim T, Buellesfeld L, Wenaweser P, Windecker S, Moschovitis A, Jaguszewski M, Landmesser U, Nietlispach F, Meier B (2015) Early results of first versus second generation Amplatzer occluders for left atrial appendage closure in patients with atrial fibrillation. Clin Res Cardiol 104:656–665 [Epub 2015/03/05]

    Article  PubMed  Google Scholar 

  15. Ewen S, Rettig-Ewen V, Mahfoud F, Bohm M, Laufs U (2014) Drug adherence in patients taking oral anticoagulation therapy. Clin Res Cardiol 103:173–182 [Epub 2013/09/04]

    Article  CAS  PubMed  Google Scholar 

  16. Hanazawa K, Brunelli M, Geller JC (2014) Thromboembolic stroke after cardioversion with incomplete left atrial appendage closure. Clin Res Cardiol 103:835–837 [Epub 2014/05/14]

    Article  PubMed  Google Scholar 

  17. Wasmer K, Kobe J, Dechering D, Milberg P, Pott C, Vogler J, Stypmann J, Waltenberger J, Monnig G, Breithardt G, Eckardt L (2013) CHADS(2) and CHA(2)DS (2)-VASc score of patients with atrial fibrillation or flutter and newly detected left atrial thrombus. Clin Res Cardiol 102:139–144 [Epub 2012/09/18]

    Article  PubMed  Google Scholar 

  18. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D (2011) ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 32:2999–3054 [Epub 2011/08/30]

    Article  PubMed  Google Scholar 

  19. Spilker J, Kongable G, Barch C, Braimah J, Brattina P, Daley S, Donnarumma R, Rapp K, Sailor S (1997) Using the NIH Stroke Scale to assess stroke patients. The NINDS rt-PA Stroke Study Group. J Neurosci Nurs 29:384–392 [Epub 1998/02/28]

  20. De Luca G, Dirksen MT, Spaulding C, Kelbaek H, Schalij M, Thuesen L, van der Hoeven B, Vink MA, Kaiser C, Musto C, Chechi T, Spaziani G, de la Llera LS, Pasceri V, Di Lorenzo E, Violini R, Suryapranata H, Stone GW (2014) Drug-eluting stents in patients with anterior STEMI undergoing primary angioplasty: a substudy of the DESERT cooperation. Clin Res Cardiol 103:685–699 [Epub 2014/04/02]

    Article  PubMed  Google Scholar 

  21. Seivani Y, Abdel-Wahab M, Geist V, Richardt G, Sulimov DS, El-Mawardy M, Toelg R, Akin I (2013) Long-term safety and efficacy of dual therapy with oral anticoagulation and clopidogrel in patients with atrial fibrillation treated with drug-eluting stents. Clin Res Cardiol 102:799–806 [Epub 2013/06/19]

    Article  CAS  PubMed  Google Scholar 

  22. Wiebe J, Mollmann H, Most A, Dorr O, Weipert K, Rixe J, Liebetrau C, Elsasser A, Achenbach S, Hamm C, Nef H (2014) Short-term outcome of patients with ST-segment elevation myocardial infarction (STEMI) treated with an everolimus-eluting bioresorbable vascular scaffold. Clin Res Cardiol 103:141–148 [Epub 2013/10/19]

    Article  CAS  PubMed  Google Scholar 

  23. Zahn R, Neumann FJ, Buttner HJ, Richardt G, Schneider S, Levenson B, Tebbe U, Sabin G, Nienaber CA, Pfannebecker T, Hamm CW (2012) Long-term follow-up after coronary stenting with the sirolimus-eluting stent in clinical practice: results from the prospective multi-center German Cypher Stent Registry. Clin Res Cardiol 101:709–716 [Epub 2012/04/10]

    Article  CAS  PubMed  Google Scholar 

  24. Harle T, Zeymer U, Schwarz AK, Luers C, Hochadel M, Darius H, Kasper W, Hauptmann KE, Andresen D, Elsasser A (2014) Use of drug-eluting stents in acute myocardial infarction with persistent ST-segment elevation: results of the ALKK PCI-registry. Clin Res Cardiol 103:373–380 [Epub 2014/01/18]

    Article  PubMed  Google Scholar 

  25. Wohrle J, Rottbauer W, Imhof A (2012) Everolimus-eluting stents for treatment of chronic total coronary occlusions. Clin Res Cardiol 101:23–28 [Epub 2011/09/23]

    Article  PubMed  Google Scholar 

  26. Piccolo R, Cassese S, Galasso G, Niglio T, De Rosa R, De Biase C, Piscione F (2012) Long-term clinical outcomes following sirolimus-eluting stent implantation in patients with acute myocardial infarction. A meta-analysis of randomized trials. Clin Res Cardiol 101:885–893 [Epub 2012/05/17]

    Article  CAS  PubMed  Google Scholar 

  27. Akin I, Wiemer M, Schneider S, Senges J, Hochadel M, Richardt G, Abdel-Wahab M, Kuck KH, Nienaber CA (2012) Real-world experience of drug-eluting stents in saphenous vein grafts compared to native coronary arteries: results from the prospective multicenter German DES.DE registry. Clin Res Cardiol 101:201–208 [Epub 2011/11/15]

    Article  CAS  PubMed  Google Scholar 

  28. Cuneo A, Bramlage P, Hochadel M, Senges J, Nienaber C, Kuck KH, Tebbe U (2012) Concurrent drug eluting/bare metal stent implantation during percutaneous coronary intervention in target vessel: outcomes and 1-year follow-up. Clin Res Cardiol 101:281–288 [Epub 2011/12/14]

    Article  CAS  PubMed  Google Scholar 

  29. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123:2736–2747 [Epub 2011/06/15]

    Article  PubMed  Google Scholar 

  30. Dg A (1991) Practical statistics for medical research. Chapman and Hall, London

    Google Scholar 

  31. Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, Coresh J (2014) Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA J Am Med Assoc 312:259–268 [Epub 2014/07/17]

    Article  CAS  Google Scholar 

  32. Nakatani D, Sakata Y, Suna S, Usami M, Matsumoto S, Shimizu M, Sumitsuji S, Kawano S, Ueda Y, Hamasaki T, Sato H, Nanto S, Hori M, Komuro I (2013) Incidence, predictors, and subsequent mortality risk of recurrent myocardial infarction in patients following discharge for acute myocardial infarction. Circ J 77:439–446 [Epub 2012/10/19]

    Article  PubMed  Google Scholar 

  33. Stolker JM, Cohen DJ, Kennedy KF, Pencina MJ, Lindsey JB, Mauri L, Cutlip DE, Kleiman NS (2012) Repeat revascularization after contemporary percutaneous coronary intervention: an evaluation of staged, target lesion, and other unplanned revascularization procedures during the first year. Circ Cardiovasc Interv 5:772–782 [Epub 2012/10/25]

    Article  PubMed  Google Scholar 

  34. Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP (2011) Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke 42:1489–1494 [Epub 2011/04/02]

    Article  PubMed  Google Scholar 

  35. Tada T, Byrne RA, Simunovic I, King LA, Cassese S, Joner M, Fusaro M, Schneider S, Schulz S, Ibrahim T, Ott I, Massberg S, Laugwitz KL, Kastrati A (2013) Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients. JACC Cardiovasc Interv 6:1267–1274 [Epub 2013/12/21]

    Article  PubMed  Google Scholar 

  36. Fonarow GC, Saver JL, Smith EE, Broderick JP, Kleindorfer DO, Sacco RL, Pan W, Olson DM, Hernandez AF, Peterson ED, Schwamm LH (2012) Relationship of national institutes of health stroke scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke. J Am Heart Assoc 1:42–50 [Epub 2012/11/07]

    Article  PubMed  PubMed Central  Google Scholar 

  37. Philip F, Agarwal S, Bunte MC, Goel SS, Tuzcu EM, Ellis S, Kapadia SR (2014) Stent thrombosis with second-generation drug-eluting stents compared with bare-metal stents: network meta-analysis of primary percutaneous coronary intervention trials in ST-segment-elevation myocardial infarction [corrected]. Circ Cardiovasc Interv 7:49–61 [Epub 2013/11/28]

    Article  CAS  PubMed  Google Scholar 

  38. Sarno G, Lagerqvist B, Nilsson J, Frobert O, Hambraeus K, Varenhorst C, Jensen UJ, Todt T, Gotberg M, James SK (2014) Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI: a report from SCAAR. J Am Coll Cardiol 64:16–24 [Epub 2014/07/07]

    Article  PubMed  Google Scholar 

  39. Bobinger T, Kallmunzer B, Kopp M, Kurka N, Arnold M, Hilz MJ, Huttner HB, Schwab S, Kohrmann M (2015) Prevalence and impact on outcome of electrocardiographic early repolarization patterns among stroke patients: a prospective observational study. Clin Res Cardiol 104:666–671 [Epub 2015/02/25]

    Article  PubMed  Google Scholar 

  40. O’Neal WT, Efird JT, Kamel H, Nazarian S, Alonso A, Heckbert SR, Longstreth WT Jr, Soliman EZ (2015) The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis. Clin Res Cardiol 104:743–750 [Epub 2015/03/11]

    Article  PubMed  Google Scholar 

  41. Rasenack EC, Oehler M, Elsasser A, Schilling M, Maier LS (2013) Evaluation of a novel portable capacitive ECG system in the clinical practice for a fast and simple ECG assessment in patients presenting with chest pain: FIDET (Fast Infarction Diagnosis ECG Trial). Clin Res Cardiol 102:179–184 [Epub 2012/10/12]

    Article  PubMed  PubMed Central  Google Scholar 

  42. Weil MB, Oehler M, Schilling M, Maier LS (2012) First clinical evaluation of a novel capacitive ECG system in patients with acute myocardial infarction. Clin Res Cardiol 101:165–174 [Epub 2011/11/09]

    Article  PubMed  PubMed Central  Google Scholar 

  43. Mueller M, Celik S, Biener M, Vafaie M, Schwoebel K, Wollert KC, Januzzi JL, Katus HA, Giannitsis E (2012) Diagnostic and prognostic performance of a novel high-sensitivity cardiac troponin T assay compared to a contemporary sensitive cardiac troponin I assay in patients with acute coronary syndrome. Clin Res Cardiol 101:837–845 [Epub 2012/05/26]

    Article  CAS  PubMed  Google Scholar 

  44. Boos CJ, Mellor A, Begley J, Stacey M, Smith C, Hawkins A, Woods DR (2014) The effects of exercise at high altitude on high-sensitivity cardiac troponin release and associated biventricular cardiac function. Clin Res Cardiol 103:291–299 [Epub 2013/12/24]

    Article  CAS  PubMed  Google Scholar 

  45. Scheitz JF, Nolte CH, Laufs U, Endres M (2015) Application and interpretation of high-sensitivity cardiac troponin assays in patients with acute ischemic stroke. Stroke 46:1132–1140 [Epub 2015/03/05]

    Article  PubMed  Google Scholar 

  46. Kirchberger I, Heier M, Wende R, von Scheidt W, Meisinger C (2012) The patient’s interpretation of myocardial infarction symptoms and its role in the decision process to seek treatment: the MONICA/KORA Myocardial Infarction Registry. Clin Res Cardiol 101:909–916 [Epub 2012/05/24]

    Article  PubMed  Google Scholar 

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Acknowledgments

Part of this work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University (No. 16-2014) (to A.P.).

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Authors and Affiliations

  1. Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany

    Tobias Zeus, Ulrike Ketterer, Daniela Leuf, Lisa Dannenberg, Florian Bönner, Rabea Wagstaff, Malte Kelm & Amin Polzin

  2. Department of Neurology, Heinrich Heine University, Düsseldorf, Germany

    Michael Gliem & Sebastian Jander

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  1. Tobias Zeus
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  2. Ulrike Ketterer
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  3. Daniela Leuf
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  10. Amin Polzin
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Correspondence to Amin Polzin.

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The study conformed to the Declaration of Helsinki and was approved by the University of Düsseldorf Ethics Committee.

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Zeus, T., Ketterer, U., Leuf, D. et al. Safety of percutaneous coronary intervention in patients with acute ischemic stroke/transient ischemic attack and acute coronary syndrome. Clin Res Cardiol 105, 356–363 (2016). https://doi.org/10.1007/s00392-015-0928-y

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  • DOI: https://doi.org/10.1007/s00392-015-0928-y

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