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Ten-year mortality after treating obstructive coronary atherosclerosis with contemporary stents in patients with or
Tineke H Pinxterhuis1, Eline H Ploumen1, Daphne van Vliet2
1Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands.
Insights
Patients undergoing percutaneous coronary intervention (PCI) with peripheral arterial disease (PAD) face nearly double the 10-year mortality risk. Even after accounting for risk factors, PAD significantly increases mortality in PCI patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Peripheral arterial disease (PAD) is associated with increased adverse events in percutaneous coronary intervention (PCI) patients.
- Long-term (10-year) mortality data and causes of death in PCI patients with concomitant PAD are limited.
- Contemporary drug-eluting stents are standard in current PCI practice.
Purpose of the Study:
- To evaluate the impact of concomitant PAD on very long-term (10-year) mortality in PCI patients treated with drug-eluting stents.
- To analyze the causes of death in PCI patients with and without PAD over a 10-year period.
- To determine if PAD remains an independent predictor of mortality after adjusting for cardiovascular risk factors.
Main Methods:
- Analysis of PCI 'all-comers' from the TWENTE and DUTCH PEERS trials.
- Comparison of mortality outcomes between PCI patients with and without PAD.
- Life status ascertained via the Dutch Personal Records Database; causes of death confirmed through medical records.
Main Results:
- 10-year all-cause mortality was significantly higher in patients with PAD (41.5%) compared to those without (23.1%), corresponding to a 2.05-fold increased risk.
- No statistically significant differences were observed in the rates of death from cardiac, vascular, non-cardiovascular, or unclear causes between groups.
- Multivariate analysis confirmed PAD as an independent predictor of all-cause mortality (adjusted HR: 1.38, p=0.01) after adjusting for cardiovascular risk factors.
Conclusions:
- Concomitant PAD nearly doubles the 10-year all-cause mortality risk in PCI patients.
- Despite higher baseline cardiovascular risk factors in PAD patients, PAD independently contributes to increased long-term mortality.
- These findings underscore the importance of considering PAD in risk stratification and management of PCI patients.
Background And Aims:
Previous studies in percutaneous coronary intervention (PCI) patients showed a higher 3-year adverse event risk, including all-cause mortality, in those with concomitant peripheral arterial disease (PADs). Ten-year data of mortality and causes of death are scarce. This analysis assessed PCI patients, treated with contemporary drug-eluting stents, the impact of concomitant PADs on very long-term mortality, and causes of death.
Methods:
We assessed PCI all-comers from our center who participated in the TWENTE and DUTCH PEERS trials (clinicaltrials.gov:NCT01066650, NCT01331707), comparing patients with versus without PADs. Life status was checked in the Dutch Personal Records Database; causes of death were obtained from medical records.
Results:
Of 2705 study patients, 668 (24.7%) died during follow-up: 88/212 (41.5%) patients with PADs and 580/2493 (23.1%) without PADs. In PADs patients, the 10-year rate of all-cause mortality was about twice as high as in patients without PADs (41.5% vs.23.1%, HR: 2.05, 95%-CI: 1.64-2.57, p<0.001). For both groups, the rates of patients dying from various causes of death were: cardiac (14.1% vs.6.8%), vascular (2.8% vs. 1.1%), non-cardiovascular (17.4% vs. 9.8%), and unclear causes (7.1% vs. 5.3%), without a statistically significant between-group difference. When multivariate analysis was adjusted for between-group differences in cardiovascular risk profile, PADs remained predictor of all-cause mortality (adjusted HR: 1.38, 95%-CI: 1.08-1.75, p=0.01).
Conclusions:
The 10-year all-cause mortality rate in PCI patients with concomitant PADs was almost twice as high as in those without PADs. Age and other traditional cardiovascular risk factors were higher in patients with PADs, but after correction for these confounders PADs still accounted for almost 40% increase in mortality.
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