Nonfatal Adverse Events and Risk for Subsequent Mortality in Patients Undergoing Percutaneous Coronary Intervention.

Area of Science:

• Cardiology
• Clinical Research
• Public Health

Background:

• Current percutaneous coronary intervention (PCI) quality metrics often equally weight diverse nonfatal adverse events.
• Events like heart failure hospitalization (HFH), acute coronary syndrome (ACS), and major bleeding are frequently grouped in composite endpoints.

Purpose of the Study:

• To quantify and compare the associations of HFH, ACS, and major bleeding with subsequent mortality after PCI.
• To inform clinical decision-making and endpoint definitions by differentiating the prognostic impact of these adverse events.

Main Methods:

• Analysis of a Japanese multicenter prospective PCI registry (2008-2021) with 2-year outcomes.
• Utilized Cox proportional hazards models and population attributable fractions to assess time-varying exposures (HFH, ACS, major bleeding) and their association with all-cause mortality.
• Adjusted for conventional cardiovascular risk factors.

Main Results:

• Among 10,482 patients, 2-year cumulative incidence rates were 4.7% for HFH, 3.4% for ACS, and 2.5% for major bleeding.
• HFH demonstrated the strongest association with mortality (adjusted HR: 6.11), followed by ACS (aHR: 3.22) and major bleeding (aHR: 2.62).
• HFH accounted for a significantly larger proportion of the mortality burden (20.1%) compared to ACS (4.3%) and major bleeding (2.9%).

Conclusions:

• Heart failure hospitalization is more strongly associated with mortality post-PCI than acute coronary syndrome or major bleeding.
• This highlights the need to move beyond equally weighted composite endpoints.
• Clinical decision-making and quality metric development should prioritize events based on their differential impact on mortality.