Percutaneous coronary intervention in patients hospitalized for non-ST-elevation myocardial infarction and the risk of postdischarge ischemic stroke at 6-month, 1-year, and 3-year follow-ups

• Published in: Heart and vessels Vol. 34; no. 7; pp. 1132 - 1139
• Main Authors: Lin, Chao-Feng, Chang, Ya-Hui, Chi, Nai-Fang, Chen, I.-M.ing, Liu, Hung-Yi, Chien, Li-Nien
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.07.2019; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty; Biomedical Engineering and Bioengineering; Brain Ischemia - epidemiology; Brain Ischemia - prevention & control; Cardiac Surgery; Cardiology; Cerebral infarction; Confidence intervals; Female; Follow-Up Studies; Health risk assessment; Health risks; Heart attacks; Humans; Intervention; Ischemia; Long-term effects; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial infarction; Non-ST Elevated Myocardial Infarction - complications; Non-ST Elevated Myocardial Infarction - therapy; Original Article; Patient Discharge - statistics & numerical data; Patients; Percutaneous Coronary Intervention; Population studies; Propensity Score; Proportional Hazards Models; Registries; Retrospective Studies; Risk; Risk reduction; Severity of Illness Index; Stroke; Stroke - epidemiology; Stroke - prevention & control; Taiwan - epidemiology; Time Factors; Treatment Outcome; Vascular Surgery; Young Adult; Taiwan; Non-ST-elevation myocardial infarction; Percutaneous coronary intervention; Ischemic stroke
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-019-01367-4

Percutaneous coronary intervention (PCI) is suggested for treating patients with non-ST-elevation myocardial infarction (NSTEMI) to reduce adverse cardiovascular events. However, the short- and long-term effects of PCI on the risk of postdischarge ischemic stroke (IS) in patients hospitalized for NSTEMI remain unclear. This study investigated the association of PCI on the risk of postdischarge IS in patients hospitalized for NSTEMI at different period follow-ups. A population-based cohort study was conducted using data from Taiwan’s National Health Insurance Research Database. Propensity score matching (PSM) was used to select 6079 pairs of the patients with NSTEMI treated invasively by PCI (received PCI during hospitalization) and initial conservative strategy (did not receive PCI during hospitalization) with similar baseline characteristics for evaluation. After adjustment for patients’ clinical variables and the duration of dual antiplatelet therapy, PCI was associated with a decreased risk of postdischarge IS at 6-month, 1-year, and 3-year follow-ups [adjusted hazard ratio (aHR) = 0.41, 95% confidence interval (CI) = 0.26–0.67, p  < 0.001; aHR = 0.61, 95% CI 0.43–0.86, p  = 0.004; and aHR = 0.69, 95% CI 0.54–0.89, p  = 0.005respectively]. In the patients who had a CHA 2 DS 2 -VASc score of ≥2, PCI was also associated with a decreased risk of postdischarge IS at 6-month, 1-year, and 3-year follow-ups (aHR = 0.54, 95% CI 0.36–0.83, p  = 0.005; aHR = 0.72, 95% CI 0.52–1.00, p  = 0.048; and aHR =0.73, 95% CI 0.58–0.91, p  = 0.005, respectively). These findings suggested that PCI might reduce the risk of postdischarge IS in patients hospitalized for NSTEMI.