Late outcomes following percutaneous coronary interventions: results from a large, observational registry
Clare E Appleby1, Karen Mackie, Vladimír Dzavík
1University Health Network, University of Toronto, Ontario.
Insights
Long-term outcomes after percutaneous coronary intervention (PCI) in a real-world, high-risk patient cohort were favorable. Major adverse cardiac event rates were low, comparable to clinical trials, guiding better treatment for diverse patient groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Randomized controlled trials (RCTs) provide limited data on long-term outcomes following percutaneous coronary intervention (PCI).
- Applicability of RCT findings to the general population undergoing PCI remains uncertain.
- There is a lack of comprehensive data on long-term clinical outcomes for patients receiving PCI.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of an 'all-comers' patient group undergoing PCI.
- To assess outcomes at a high-volume, tertiary cardiac referral center.
- To provide real-world data on PCI effectiveness and safety.
Main Methods:
- Analysis of 12,662 consecutive patients in a prospective registry (April 2000-September 2007).
- In-hospital outcomes assessed, with long-term follow-up via provincial registry linkage.
- Kaplan-Meier survival analysis and Cox regression for predictors of mortality and adverse events.
Main Results:
- The cohort represented a high-risk population (19% >75 years, 28% diabetes, 61% multivessel disease).
- Seven-year all-cause mortality was 10.6%; repeat PCI in 14.2%, CABG in 4.2%.
- Incomplete revascularization, residual stenosis, and cardiogenic shock predicted poorer outcomes; men had better unadjusted survival.
Conclusions:
- Long-term major adverse cardiac event rates in this large 'all-comers' PCI registry were low.
- Outcomes align with those reported in randomized controlled trials.
- These real-world data aid in characterizing and managing high-risk patients undergoing PCI.
Background:
Randomized controlled trials report short- and medium- term outcomes following percutaneous coronary intervention (PCI), but their applicability to the general population is not known. Data regarding the long-term clinical outcomes of patients undergoing PCI are lacking.
Objective:
To determine the long-term outcomes of 'all-comers' undergoing PCI at a large-volume tertiary cardiac referral centre.
Methods:
A total of 12,662 consecutive patients undergoing an index procedure and entered into the University Health Network's (Toronto, Ontario) prospective registry between April 2000 and September 2007 were identified. In-hospital outcomes were assessed. Follow-up data were obtained through linkage to a provincial registry. Kaplan-Meier analysis was performed to calculate unadjusted survival rates, and Cox multiple regression analysis identified independent predictors of late mortality, major adverse cardiac events and all cardiovascular events.
Results:
The population included a relatively high-risk patient cohort, with 19% older than 75 years of age, 28% with diabetes, 61% with multivessel disease and 1.3% in cardiogenic shock. Urgent procedures comprised 53% of all cases. The all-cause mortality rate at seven years follow-up was 10.6%. Repeat PCI occurred in 14.2% of patients, and coronary artery bypass grafting in 4.2%. Men showed a significant unadjusted survival advantage compared with women. Procedural characteristics such as incomplete revascularization and residual stenosis, in addition to established risk factors, were predictors of poorer long-term outcomes. Cardiogenic shock was the strongest predictor of late mortality.
Conclusion:
In the present large registry of 'all-comers' for PCI, longterm major adverse cardiac event rates were low and consistent with outcomes from randomized controlled trials. These data reflect a large cohort in real-world clinical practice, and may help clinicians further characterize and better treat high-risk patients who are undergoing PCI.
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