Effect of Coronary Artery Revascularization on In-hospital Outcomes and Long-term Prognoses in Acute Myocardial Infarction Patients with Prior Ischemic Stroke

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2016 May 12

PMID 27168740

Authors

Bo-Yu Li

Xiao-Ming Li

Yan Zhang

Zhan-Yun Wei

Jing Li

Qi Hua

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate whether coronary artery revascularization therapies (CART), including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), can improve the in-hospital and long-term outcomes for acute myocardial infarction (AMI) patients with prior ischemic stroke (IS).

Methods: A total of 387 AMI patients with prior IS were enrolled consecutively from January 15, 2005 to December 24, 2011 in this cohort study. All patients were categorized into the CART group (n = 204) or the conservative medications (CM) group (n = 183). In-hospital cardiocerebral events and long-term mortality of the two groups after an average follow-up of 36 months were recorded by Kaplan-Meier survival curves and compared by Logistic regression and the Cox regression model.

Results: The CART patients were younger (66.5 ± 9.7 years vs. 71.7 ± 9.7 years, P < 0.01), had less non-ST segment elevation myocardial infarction (11.8% vs. 20.8%, P = 0.016) and more multiple-vascular coronary lesions (50% vs. 69.4%, P = 0.031). The hospitalization incidence of cardiocerebral events in the CART group was 9.3% while 26.2% in the CM group (P < 0.01). CART significantly reduced the risk of in-hospital cardiocerebral events by 65% [adjusted odds ratio (OR) = 0.35, 95% CI: 0.13-0.92]. By the end of follow-up, 57 cases (41.6%) died in CM group (n = 137) and 24 cases (12.2%) died in CART group (n = 197). Cox regression indicated that CART decreased the long-term mortality by 72% [adjusted hazard ratio (HR) = 0.28, 95% CI: 0.06-0.46], while categorical analysis indicated no significant difference between PCI and CABG.

Conclusions: CART has a significant effect on improving the in-hospital and long-term prognoses for AMI patients with prior IS.

References

Smit Y, Vlayen J, Koppenaal H, Eefting F, Kappetein A, Mariani M . Percutaneous coronary invervention versus coronary artery bypass grafting: a meta-analysis. J Thorac Cardiovasc Surg. 2014; 149(3):831-8.e1-13. DOI: 10.1016/j.jtcvs.2014.10.112. View

. The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. N Engl J Med. 1993; 329(22):1615-22. DOI: 10.1056/NEJM199311253292204. View

Capodanno D, Capranzano P, Tamburino C . CABG versus PCI in diabetic patients with multivessel disease after risk stratification by the SYNTAX score: a pooled analysis of the SYNTAX and FREEDOM trials. Int J Cardiol. 2014; 173(3):548-9. DOI: 10.1016/j.ijcard.2014.03.077. View

Alfonso F, Collet J, Cremer J, Falk V, Filippatos G, Hamm C . 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.... Eur J Cardiothorac Surg. 2014; 46(4):517-92. DOI: 10.1093/ejcts/ezu366. View

Kristensen S, Laut K, Fajadet J, Kaifoszova Z, Kala P, Di Mario C . Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J. 2014; 35(29):1957-70. DOI: 10.1093/eurheartj/eht529. View

Li Y, Rha S, Chen K, Jin Z, Minami Y, Wang L . Clinical characteristics and mid-term outcomes of acute myocardial infarction patients with prior cerebrovascular disease in an Asian population: Lessons from the Korea Acute Myocardial Infarction Registry. Clin Exp Pharmacol Physiol. 2010; 37(5-6):581-6. DOI: 10.1111/j.1440-1681.2010.05363.x. View

Ng V, Lansky A, Meller S, Witzenbichler B, Guagliumi G, Peruga J . The prognostic importance of left ventricular function in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Eur Heart J Acute Cardiovasc Care. 2014; 3(1):67-77. PMC: 3932775. DOI: 10.1177/2048872613507149. View

Omar H . Myocardial infarction-stroke association. Int J Cardiol. 2011; 154(3):340. DOI: 10.1016/j.ijcard.2011.10.023. View

Han Y, Zhang S, Lin S, Shen Z, Fan Z, Wang C . [Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke]. Zhonghua Xin Xue Guan Bing Za Zhi. 2012; 39(11):980-3. View

10.

Kajermo U, Ulvenstam A, Modica A, Jernberg T, Mooe T . Incidence, trends, and predictors of ischemic stroke 30 days after an acute myocardial infarction. Stroke. 2014; 45(5):1324-30. DOI: 10.1161/STROKEAHA.113.001963. View

11.

Morice M, Serruys P, Kappetein A, Feldman T, Stahle E, Colombo A . Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation. 2014; 129(23):2388-94. DOI: 10.1161/CIRCULATIONAHA.113.006689. View

12.

Morrow D, Wiviott S, White H, Nicolau J, Bramucci E, Murphy S . Effect of the novel thienopyridine prasugrel compared with clopidogrel on spontaneous and procedural myocardial infarction in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in.... Circulation. 2009; 119(21):2758-64. DOI: 10.1161/CIRCULATIONAHA.108.833665. View

13.

Simpson C, Buckley B, McLernon D, Sheikh A, Murphy A, Hannaford P . Five-year prognosis in an incident cohort of people presenting with acute myocardial infarction. PLoS One. 2011; 6(10):e26573. PMC: 3197664. DOI: 10.1371/journal.pone.0026573. View

14.

Jeong D, Lee Y, Chung S, Jeong J, Kim W, Sung K . Revascularization in left main coronary artery disease: comparison of off-pump coronary artery bypass grafting vs percutaneous coronary intervention. Eur J Cardiothorac Surg. 2013; 44(4):718-24. DOI: 10.1093/ejcts/ezt054. View

15.

Rufa M, Schubel J, Ulrich C, Schaarschmidt J, Tiliscan C, Bauer A . A retrospective comparative study of minimally invasive extracorporeal circulation versus conventional extracorporeal circulation in emergency coronary artery bypass surgery patients: a single surgeon analysis. Interact Cardiovasc Thorac Surg. 2015; 21(1):102-7. DOI: 10.1093/icvts/ivv103. View

16.

Sacco R, Adams R, Albers G, Alberts M, Benavente O, Furie K . Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the.... Stroke. 2006; 37(2):577-617. DOI: 10.1161/01.STR.0000199147.30016.74. View

17.

Ugalde H, Ugalde D, Munoz M . [Angioplasty compared to thrombolysis as the initial reperfusion therapy in acute myocardial infarction]. Rev Med Chil. 2012; 139(11):1396-402. DOI: /S0034-98872011001100002. View

18.

Alpert J, Thygesen K, Antman E, Bassand J . Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol. 2000; 36(3):959-69. DOI: 10.1016/s0735-1097(00)00804-4. View

19.

Nah H, Lee J, Chung C, Choo S, Kwon S, Kim J . New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: lesion patterns, mechanism, and predictors. Ann Neurol. 2014; 76(3):347-55. DOI: 10.1002/ana.24238. View

20.

Fox K, Clayton T, Damman P, Pocock S, de Winter R, Tijssen J . Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol. 2010; 55(22):2435-45. DOI: 10.1016/j.jacc.2010.03.007. View