Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Nov 2019)

Ischemic and Bleeding Risk After Percutaneous Coronary Intervention in Patients With Prior Ischemic and Hemorrhagic Stroke

  • Masahiro Natsuaki,
  • Takeshi Morimoto,
  • Hirotoshi Watanabe,
  • Yoshihisa Nakagawa,
  • Yutaka Furukawa,
  • Kazushige Kadota,
  • Takashi Akasaka,
  • Keiichi Igarashi Hanaoka,
  • Ken Kozuma,
  • Kengo Tanabe,
  • Yoshihiro Morino,
  • Toshiya Muramatsu,
  • Takeshi Kimura

DOI
https://doi.org/10.1161/JAHA.119.013356
Journal volume & issue
Vol. 8, no. 22

Abstract

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Background Prior stroke is regarded as risk factor for bleeding after percutaneous coronary intervention (PCI). However, there is a paucity of data on detailed bleeding risk of patients with prior hemorrhagic and ischemic strokes after PCI. Methods and Results In a pooled cohort of 19 475 patients from 3 Japanese PCI studies, we assessed the influence of prior hemorrhagic (n=285) or ischemic stroke (n=1773) relative to no‐prior stroke (n=17 417) on ischemic and bleeding outcomes after PCI. Cumulative 3‐year incidences of the co‐primary bleeding end points of intracranial hemorrhage, non‐intracranial global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries (GUSTO) moderate/severe bleeding, and the primary ischemic end point of ischemic stroke/myocardial infarction were higher in the prior hemorrhagic and ischemic stroke groups than in the no‐prior stroke group (6.8%, 2.5%, and 1.3%, P<0.0001, 8.8%, 8.0%, and 6.0%, P=0.001, and 12.7%, 13.4%, and 7.5%, P<0.0001). After adjusting confounders, the excess risks of both prior hemorrhagic and ischemic strokes relative to no‐prior stroke remained significant for intracranial hemorrhage (hazard ratio (HR) 4.44, 95% CI 2.64–7.01, P<0.0001, and HR 1.52, 95% CI 1.06–2.12, P=0.02), but not for non‐intracranial bleeding (HR 1.18, 95% CI 0.76–1.73, P=0.44, and HR 0.94, 95% CI 0.78–1.13, P=0.53). The excess risks of both prior hemorrhagic and ischemic strokes relative to no‐prior stroke remained significant for ischemic events mainly driven by the higher risk for ischemic stroke (HR 1.46, 95% CI 1.02–2.01, P=0.04, and HR 1.49, 95% CI 1.29–1.72, P<0.0001). Conclusions Patients with prior hemorrhagic or ischemic stroke as compared with those with no‐prior stroke had higher risk for intracranial hemorrhage and ischemic events, but not for non‐intracranial bleeding after PCI.

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