LAUSR

‐term risk of stroke following PCI 1 predictors for stroke determined by Zhao et al,5 including AF6 and age,7 seem fitting when eval‐ uating evidence from the wider literature, al‐ though some are counterintuitive and lack bio‐ logical plausibility. The authors identified treatment of side branch disease as a predictor of future stroke. Whilst treatment of bifurcation lesions and side branch‐ es may increase the risk of major adverse cardio‐ vascular and cerebrovascular events,8 it is un‐ clear why it should increase long ‐term risk of ischemic stroke. Furthermore, some findings of Zhao et al5 appear to be at odds with a large body of literature. Paradoxically, the authors report that patients belonging to the youngest age cat‐ egory (≤40 years) had the greatest risk of stroke. They reasoned that older patients who are frail may be less likely to be chosen candidates for PCI, and therefore, the older population in their study is more “robust.” Contemporary practice does not exclude older patients from PCI, even when the burden of comorbidities is significant, as the benefit associated with the procedure out‐ weighs potential risks. There is no age cutoff in the contemporary guidelines for provision of PCI. Thus, this assertion is very unlikely. It is more likely that the apparent “lower ‐risk” observed in older people may be explained by the competing risk of death which was not considered. Whilst the model by Zhao et al5 has shown good discriminative performance, some signifi‐ cant limitations should be acknowledged. First‐ ly, the prediction model focuses only on ischemic stroke. The clinical utility is therefore uncertain, particularly in a population treated with potent antithrombotic regimes where longer ‐term risk of hemorrhagic stroke remains significant. Sec‐ ondly, stroke in this group of patients is likely to represent 2 different pathophysiologic processes Percutaneous coronary intervention (PCI) reduc‐ es mortality and reinfarction after type 1 myocar‐ dial infarction (MI) and represents the contem‐ porary gold ‐standard invasive treatment. Despite a relatively low incidence ranging from 0.22% to 1.3%,1 PCI ‐related stroke is associated with high acute mortality rates and life ‐changing dis‐ abilities in patients who survive.2 To date, many studies have therefore focused on periprocedur‐ al stroke following PCI, its predictors and com‐ plications.2-4 Long ‐term stroke risk in this pop‐ ulation is less well researched. Assessment of this risk is important as these patients are mul‐ timorbid, older people with a higher burden of cardiovascular risk factors and are often treated with potent antithrombotic regimes. Therefore, this population represents a completely differ‐ ent group of patients to those in the communi‐ ty that most stroke risk prediction scores serve and were developed in. Zhao et al5 contribute to this evidence gap in the current issue of Polish Archives of Internal Medicine (Pol Arch Intern Med). They derived and validated a prediction model to determine the 5 ‐year risk of stroke in patients who had un‐ dergone PCI for acute MI at Fuwai Hospital, Bei‐ jing, China.5 They retrospectively analyzed 4103 patients who had been treated with PCI for acute coronary syndrome indications; 3582 with ST‐ ‐segment elevation myocardial infarction (STEMI) and 521 with non ‐STEMI. Among variables as‐ sessed, a history of hypertension, atrial fibril‐ lation (AF), age group, and the presence of tar‐ get lesions involving branches formed predictors in their model. Further, the authors developed a nomogram and performed an internal valida‐ tion. The area under the curve of the validation cohort was 0.846 with appreciably high sensi‐ tivity (71.43%) and specificity (90.29%). Several EDITORIAL