Clinical, procedural, and follow-up outcomes of percutaneous coronary intervention-related stroke: insight from the PROGRESS-COMPLICATIONS registry.

Abstract

Background: Stroke is an infrequent but potentially severe complication of percutaneous coronary intervention (PCI).

Methods: The authors describe the clinical features, angiographic characteristics, and procedural and follow-up outcomes of PCI-related stroke in the PROGRESS-COMPLICATIONS registry.

Results: Of 22 503 patients who underwent PCI at 2 tertiary care centers between 2016 and 2023, 157 (0.7%) had PCI-related stroke: 10 (6.4%) had hemorrhagic stroke while 147 (93.6%) had ischemic stroke. The mean age of the stroke patients was 70 ± 11 years; 63.1% were men, 25.2% had prior heart failure, 71.0% had diabetes mellitus, 85.4% had hypertension, and 36.6% had chronic kidney disease. Radial access was used in 39.5% of the patients; 31.1% of stroke patients presented with ST-segment elevation myocardial infarction (STEMI), 49.7% with non-STEMI, and 14.6% with stable angina. The target lesions were complex: 47.1% were bifurcations, 63.7% had moderate to severe calcification, and 56.0% had thrombus. The mean minimum activated clotting time of the stroke patients was 214 (165, 245) seconds. Technical success was 93%. A mechanical circulatory support device was utilized in 31 (20%) of the patients, and 17 (10.8%) presented with cardiogenic shock. Hypotension during the procedure occurred in 36 patients (22.9%), bleeding occurred in 37 (23.6), and in-hospital mortality was 13.7%. During a median follow-up of 32 months, 48.3% of the patients had follow-up major adverse cardiovascular events (MACE) and 24.5% died.

Conclusions: Stroke is an infrequent but severe complication of PCI, associated with high mortality and MACE. Most periprocedural strokes were ischemic.