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Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction

Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction
Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction

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.

Adolescent, Adult, Aged, Aged, 80 and over, England/epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Percutaneous Coronary Intervention/methods, Postoperative Period, Prospective Studies, Registries, Risk Factors, ST Elevation Myocardial Infarction/diagnosis, Survival Rate/trends, Time Factors, Treatment Outcome, Wales/epidemiology, Young Adult
0195-668X
68-77
Brogan, Richard A
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Alabas, Oras
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Almudarra, Sami
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Hall, Marlous
99c3916e-5cfe-4e5f-a388-4727140accb5
Dondo, Tatendashe B
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Mamas, Mamas A
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Baxter, Paul D
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Batin, Phillip D
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Curzen, Nick
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de Belder, Mark
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Ludman, Peter F
ed96bc44-311b-4a55-88d9-ce83bab3e791
Gale, Chris P
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Brogan, Richard A
f24beefd-9692-4f9f-a1a9-db1289fa84ff
Alabas, Oras
d5ccad2d-db7a-4a66-b9c7-a4ff3f7c8c7b
Almudarra, Sami
d3f312a4-5d1b-4dc5-afbc-822361f1aaf9
Hall, Marlous
99c3916e-5cfe-4e5f-a388-4727140accb5
Dondo, Tatendashe B
d62bfcb2-ae5b-418a-b44f-dd4098660398
Mamas, Mamas A
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Baxter, Paul D
00da5452-5991-4f73-ad07-37839ff08977
Batin, Phillip D
029db9df-4ce4-43dc-ae33-a46a9e1e4ee5
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
de Belder, Mark
3d0eff51-f1d1-41a7-aac1-e193db082360
Ludman, Peter F
ed96bc44-311b-4a55-88d9-ce83bab3e791
Gale, Chris P
96b5706c-fd86-4b41-9568-3d917ef2c805

Brogan, Richard A, Alabas, Oras, Almudarra, Sami, Hall, Marlous, Dondo, Tatendashe B, Mamas, Mamas A, Baxter, Paul D, Batin, Phillip D, Curzen, Nick, de Belder, Mark, Ludman, Peter F and Gale, Chris P (2019) Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. European Heart Journal, 8 (1), 68-77. (doi:10.1177/2048872617710790).

Record type: Article

Abstract

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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PPCI Relative Survival and Excess Mortality REVISED MM - Accepted Manuscript
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Accepted/In Press date: 30 April 2017
e-pub ahead of print date: 10 July 2017
Published date: 1 February 2019
Keywords: Adolescent, Adult, Aged, Aged, 80 and over, England/epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Percutaneous Coronary Intervention/methods, Postoperative Period, Prospective Studies, Registries, Risk Factors, ST Elevation Myocardial Infarction/diagnosis, Survival Rate/trends, Time Factors, Treatment Outcome, Wales/epidemiology, Young Adult

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Local EPrints ID: 429308
URI: https://eprints.soton.ac.uk/id/eprint/429308
ISSN: 0195-668X
PURE UUID: a31309d9-6098-4847-a488-f1f78f6bcd4e

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Date deposited: 26 Mar 2019 17:30
Last modified: 15 Aug 2019 04:01

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Contributors

Author: Richard A Brogan
Author: Oras Alabas
Author: Sami Almudarra
Author: Marlous Hall
Author: Tatendashe B Dondo
Author: Mamas A Mamas
Author: Paul D Baxter
Author: Phillip D Batin
Author: Nick Curzen
Author: Mark de Belder
Author: Peter F Ludman
Author: Chris P Gale

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