Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation
Richard A Brogan1, Oras Alabas1, Sami Almudarra1
11 MRC Medical Bioinformatics Centre, University of Leeds, UK.
Insights
Primary percutaneous coronary intervention for ST-elevation myocardial infarction offers excellent survival, but age and comorbidities increase long-term mortality risk. Accounting for non-cardiovascular deaths is crucial for accurate efficacy assessment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- High survival rates are reported after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
- Contemporary studies often report overall survival, potentially masking long-term risks.
Purpose of the Study:
- To assess long-term survival after primary PCI for STEMI, adjusting for non-cardiovascular deaths.
- To identify factors associated with poor long-term outcomes following primary PCI for STEMI.
Main Methods:
- Utilized the UK Percutaneous Coronary Intervention registry (n=88,188, 2005-2013).
- Matched PCI cases with UK mortality data to calculate relative survival.
- Analyzed factors associated with excess mortality.
Main Results:
- Crude five-year relative survival was 87.1%.
- Increasing age, cardiogenic shock, renal failure, left main stem stenosis, diabetes, previous myocardial infarction, and female sex were associated with excess mortality.
- Stent deployment (especially drug-eluting stents), radial access, and previous PCI were protective.
Conclusions:
- Long-term cardiovascular survival after primary PCI for STEMI is excellent.
- Failure to account for non-cardiovascular deaths may underestimate primary PCI efficacy.
- Age and specific comorbidities significantly impact long-term outcomes.
Background::
High survival rates are commonly reported following primary percutaneous coronary intervention for ST-elevation myocardial infarction, with most contemporary studies reporting overall survival.
Aims::
The aim of this study was to describe survival following primary percutaneous coronary intervention for ST-elevation myocardial infarction corrected for non-cardiovascular deaths by reporting relative survival and investigate clinically significant factors associated with poor long-term outcomes.
Methods And Results::
Using the prospective UK Percutaneous Coronary Intervention registry, primary percutaneous coronary intervention cases ( n=88,188; 2005-2013) were matched to mortality data for the UK populace. Crude five-year relative survival was 87.1% for the patients undergoing primary percutaneous coronary intervention and 94.7% for patients <55 years. Increasing age was associated with excess mortality up to four years following primary percutaneous coronary intervention (56-65 years: excess mortality rate ratio 1.61, 95% confidence interval 1.46-1.79; 66-75 years: 2.49, 2.26-2.75; >75 years: 4.69, 4.27-5.16). After four years, there was no excess mortality for ages 56-65 years (excess mortality rate ratio 1.27, 0.95-1.70), but persisting excess mortality for older groups (66-75 years: excess mortality rate ratio 1.72, 1.30-2.27; >75 years: 1.66, 1.15-2.41). Excess mortality was associated with cardiogenic shock (excess mortality rate ratio 6.10, 5.72-6.50), renal failure (2.52, 2.27-2.81), left main stem stenosis (1.67, 1.54-1.81), diabetes (1.58, 1.47-1.69), previous myocardial infarction (1.52, 1.40-1.65) and female sex (1.33, 1.26-1.41); whereas stent deployment (0.46, 0.42-0.50) especially drug eluting stents (0.27, 0.45-0.55), radial access (0.70, 0.63-0.71) and previous percutaneous coronary intervention (0.67, 0.60-0.75) were protective.
Conclusions::
Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, long-term cardiovascular survival is excellent. Failure to account for non-cardiovascular death may result in an underestimation of the efficacy of primary percutaneous coronary intervention.
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