Coronary artery disease
Long-Term Predictors of Mortality After Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents

https://doi.org/10.1016/j.amjcard.2011.05.024Get rights and content

The aim was to examine timing, causes, and predictors of death during long-term follow-up after contemporary percutaneous coronary intervention (PCI) using a large multicenter Australian registry. The cohort consisted of 10,682 consecutive patients from the Melbourne Interventional Group registry undergoing PCI (February 2004 through November 2009). For the first time in Australia, long-term mortality rates of a PCI cohort were defined by linkage to the National Death Index database. The cohort (mean age 64 ± 12 years) comprised 75% men, 24% diabetics, 59% with multivessel disease, 4.4% with renal failure, 25% with ST-elevation myocardial infarction (STEMI), 2.5% with cardiogenic shock, and 5.1% with heart failure. Drug-eluting stents (DES) were used in 43% of cases. Mean follow-up was 3.2 ± 0.5 years. In-hospital, 30-day, 12-month, and long-term (3.2 ± 0.5 years) mortalities were 1.6% (80% cardiac), 2.1% (79%), 3.9% (61%), and 8.2% (50%), respectively. Independent predictors of long-term mortality included age (hazard ratio 1.05, 95% confidence interval 1.04 to 1.06), cardiogenic shock (4.58, 3.60 to 5.83), renal failure (3.14, 2.58 to 3.82), previous heart failure (1.97, 1.60 to 2.41), STEMI (1.79, 1.47 to 2.18), peripheral vascular disease (1.72, 1.4 to 2.11), non-STEMI (1.58, 1.32 to 1.90), multivessel disease (1.47, 1.24 to 1.74), current smoking (1.39, 1.12 to 1.71), diabetes (1.36, 1.16 to 1.59), and cerebrovascular disease (1.33, 1.06 to 1.60, p <0.01 for all comparisons). DES deployment appeared protective against late mortality (hazard ratio 0.85, 0.73 to 0.99, p = 0.04); however, after 30 days, there was no difference in mortality rates between those who received a bare metal stent and those who received a DES. In conclusion, different clinical variables such as renal and heart failure predicted long-term mortality after PCI, whereas DES use in this large registry was not associated with late mortality risk.

Section snippets

Methods

The cohort consisted of all consecutive patients from the MIG registry undergoing PCI over a 6-year period for whom prospectively collected data were available. We report complete demographic, clinical, and procedural characteristics of the total PCI population enrolled to date. Standard techniques were used for all PCIs. Choice of anticoagulation, use of glycoprotein IIb/IIIa antagonists, intravascular ultrasound, and other procedural devices were left to the discretion of the operator. Oral

Results

The cohort consisted of 10,682 consecutive patients from the MIG registry undergoing PCI (from February 2004 through November 2009) with a mean follow-up of 3.2 ± 0.5 years. Baseline demographic, lesion-related, and procedural characteristics are presented for the total cohort and then analyzed according to stent type (DES vs BMS; Tables 1 and 2).

The cohort was relatively high risk with 24% diabetics, 63% presenting with an acute coronary syndrome, 49% with complex type B2/C lesions, and 59%

Discussion

Our study represents the largest contemporary analysis of cause and timing of death after PCI in Australia. The data depict clinical outcomes from a “real-world” population of consecutive patients and thus reflect outcomes of a more challenging cohort of patients than those included in randomized controlled trials. A large proportion of patients in the MIG cohort presented with acute coronary syndromes and complex lesions, yet overall mortality remained low at extended follow-up. Our reported

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    The Melbourne Interventional Group acknowledges unrestricted educational grant funding from Abbott Vascular, Abbott Australasia Pty Ltd, Pharmaceuticals, Nutritionals and EAS, NSW, Australia, Astra-Zeneca, NSW, Australia, Biotronik, NSW, Australia, Boston-Scientific, NSW, Australia, Bristol-Myers Squibb, Victoria, Australia, CSL, Victoria, Australia, Johnson & Johnson, NSW, Australia, Medtronic, Melbourne, Australia, Pfizer, NSW, Australia, Schering-Plough, NSW, Australia, Sanofi-Aventis, NSW, Australia, Servier, Victoria, Australia. Dr. Duffy's work is supported by a grant from the National Health and Medical Research Council of Australia.

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