Determinants and clinical outcomes of stroke following revascularization among patients with reduced ejection fraction

Abstract

Abstract Objective Stoke after revascularization including both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is an uncommon but devastating complication. Patients with reduced ejection fraction (EF) had an increased risk of stroke after revascularization. However, little is known about the determinants and outcomes of stroke among patients with reduced EF following revascularization. Materials and Methods A cohort study of patients with preoperative reduced EF (≤40%) who received revascularization by either PCI or CABG between January 1, 2005 and December 31, 2014 was performed. Multivariate logistic regression was used to identify independent correlates of stroke. Logistic regression models were applied to evaluate the association of stroke with clinical outcomes. Results A total of 1937 patients were enrolled in this study. Of these, 111 (5.7%) patients suffered from stroke during the median 3.5‐year follow‐up. Older age (odds ratio [OR], 1.03; 95% CI, 1.01–1.05; p = .009), history of hypertension (OR, 1.79; 95% CI, 1.18–2.73; p = .007), and history of stroke (OR, 2.00; 95% CI, 1.19–3.36; p = .008) were found to be independent predictors for stroke. Patients with and without stroke had similar risk of all‐cause death (OR, 0.91; 95% CI, 0.59–1.41; p = .670). However, stroke was associated with higher odds ratio of heart failure (HF) hospitalization (OR, 2.77; 95% CI, 1.74–4.40; p < .001) and composite end point (OR, 1.61; 95% CI, 1.07–2.42; p = .021). Conclusions Further research appears warranted to minimize the complication of stroke and improve long‐term outcomes among patients with reduced EF who underwent such high risk revascularization procedural.

Keywords

• ejection fraction
• heart failure
• revascularization
• stroke