Cardiac catheterization and acute ischemic stroke: who is at risk?

Background: Cardiac catherization is a well-established invasive procedure that is used to diagnose and treat coronary artery disease. Estimated annual rates for cardiac catherization range from 171 to 650 per 100,000 population (\u3e20 years of age) for both sexes. Cardiac catherization has been associated with an increased risk of acute ischemic stroke. Timely and specialized treatment of ischemic stroke is crucial for increasing survival and reducing morbidity. Purpose: Identify predictors of acute ischemic stroke in patients undergoing cardiac catherization procedure. Methods: Data on patients who underwent cardiac catherization from January 2008 to March 2017 was retrospectively collected and analyzed. Demographics and comorbidities were compared among those patients with and without incident stroke using area under the curve c-statistic. Results: A total of 35,268 patients were included in the study. Of these, 59% were male, 87.5% were white, 10.7% were black, and mean age was 66.1 ± 12.7 years. Acute ischemic stroke was reported among only 0.4% of these patients. The main predictors for acute ischemic stroke, based on a c-statistic of 0.68, were age (in 10-year increment) at the time of procedure (adjusted odds ratio [aOR]: 1.37, 95% CI: 1.10–1.63; P\u3c0.001), atrial fibrillation (aOR: 2.36, 95% CI: 1.16–4.80; P=0.0182), hypertension (aOR: 0.53, 95% CI: 0.34–0.82; P=0.0046), and history of stroke (aOR: 3.15, 95% CI: 1.94–5.11; P\u3c0.001). Conclusion: Retrospective assessment of nearly 10 years of cardiac catherization procedures in a single center revealed that incident acute ischemic stroke is a relatively rare occurrence. The independent predictors for stroke were age, atrial fibrillation, and history of prior stroke. Importantly, hypertension was found to be protective of acute ischemic stroke; however, data on evidencebased therapy (such as beta blocker, statin, or antiplatelet use) were not analyzed due to missing values for more than two-thirds of the patients. In the future we will strive to develop a risk score for predicting acute ischemic stroke among the patient population undergoing cardiac catherization