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. 2023 Jan 20;12(3):840.
doi: 10.3390/jcm12030840.

Acute Ischemic Stroke and Transient Ischemic Attack in ST-Segment Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention

Tsukasa Murakami  1 , Kenichi Sakakura  1 , Hiroyuki Jinnouchi  1 , Yousuke Taniguchi  1 , Takunori Tsukui  1 , Yusuke Watanabe  1 , Kei Yamamoto  1 , Masaru Seguchi  1 , Hiroshi Wada  1 , Hideo Fujita  1
Affiliations

Acute Ischemic Stroke and Transient Ischemic Attack in ST-Segment Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention

Tsukasa Murakami et al. J Clin Med. .

Abstract

Background: Acute ischemic stroke (AIS) is a rare but critical complication following ST-elevation myocardial infarction (STEMI). The risk of AIS or transient ischemic attack (TIA) may be amplified by invasive procedures, including primary percutaneous coronary intervention (PCI). This study aimed to investigate the factors associated with in-hospital AIS/TIA in patients with STEMI who required primary PCI.

Methods: We included 941 STEMI patients who underwent primary PCI and divided them into an AIS/TIA group (n = 39) and a non-AIS/TIA group (n = 902), according to new-onset AIS/TIA. The primary interest was to find the factors associated with AIS/TIA by multivariate logistic regression analysis. We also compared clinical outcomes between the AIS/TIA and non-AIS/TIA groups.

Results: The incidence of in-hospital deaths was significantly higher in the AIS/TIA group (46.2%) than in the non-AIS/TIA group (6.3%) (p < 0.001). Multivariate analysis revealed that cardiogenic shock (OR 3.228, 95% CI 1.492-6.986, p = 0.003), new-onset atrial fibrillation (AF) (OR 2.280, 95% CI 1.033-5.031, p = 0.041), trans-femoral approach (OR 2.336, 95% CI 1.093-4.992, p = 0.029), use of ≥4 catheters (OR 3.715, 95% CI 1.831-7.537, p < 0.001), and bleeding academic research consortium (BARC) type 3 or 5 bleeding (OR 2.932, 95% CI 1.256-6.846, p = 0.013) were significantly associated with AIS/TIA.

Conclusion: In STEMI patients with primary PCI, new-onset AIS/TIA was significantly associated with cardiogenic shock, new-onset AF, trans-femoral approach, the use of ≥4 catheters, and BARC type 3 or 5 bleeding. We should recognize these modifiable and unmodifiable risk factors for AIS/TIA in the treatment of STEMI.

Keywords: acute ischemic stroke; coronary angiography; primary percutaneous coronary intervention; transient ischemic attack.

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Conflict of interest statement

K.S. has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, Japan Lifeline, Kaneka, and NIPRO; he has served as a proctor for Rotablator for Boston Scientific, and he has served as a consultant for Abbott Vascular and Boston Scientific. H.F. has served as a consultant for Mehergen Group Holdings, Inc. Other authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
The study flow chart. Abbreviations: AIS = acute ischemic stroke, CAG = coronary angiography, PCI = percutaneous coronary intervention, STEMI = ST-segment elevation myocardial infarction, TIA = transient ischemic attack.
Figure 2
Figure 2
The distribution of the onset-day of AIS/TIA. The peak period of the occurrence of AIS/TIA was within 24 h of admission. Abbreviations: AIS = acute ischemic stroke, TIA = transient ischemic attack.
See this image and copyright information in PMC

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