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Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention

Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention
Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention

OBJECTIVE: For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality.

METHODS: A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI-CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56.6 million people. Relative survival and excess mortality were estimated.

RESULTS: Over 26 105 person-years follow-up, crude 5-year relative survival was 93.8% for CSA, 73.1% for NSTEACS, 77.5% for STEMI-CS and 28.5% for STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73, 95% CI 4.06 to 11.15), and for NSTEACS and STEMI-CS was preprocedural ventilation (6.25, 5.05 to 7.75 and 6.92, 4.25 to 11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural thrombolysis in myocardial infarction (TIMI) 0 flow (2.78, 1.87 to 4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61 to 0.90).

CONCLUSIONS: Long-term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI-CS, the requirement for preprocedural ventilation was the strongest determinant of excess mortality. By contrast, among STEMI+CS, in whom survival was poor, the strongest determinant was preprocedural TIMI flow. Future cardiovascular cohort studies of long-term mortality should consider the impact of non-cardiovascular deaths.

Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Angina, Stable/diagnosis, Cause of Death, Comorbidity, Coronary Artery Disease/diagnosis, Coronary Circulation, Female, Humans, Male, Middle Aged, Non-ST Elevated Myocardial Infarction/diagnosis, Percutaneous Coronary Intervention/adverse effects, Registries, Respiration, Artificial/adverse effects, Risk Assessment, Risk Factors, ST Elevation Myocardial Infarction/diagnosis, Sex Factors, Survivors, Time Factors, Treatment Outcome, United Kingdom/epidemiology, Young Adult
1355-6037
1287-1295
Alabas, O.A.
1365daa2-c294-46f3-9bc4-32487ba25c27
Brogan, R.A.
f24beefd-9692-4f9f-a1a9-db1289fa84ff
Hall, M.
b813c2f9-7a95-4fe1-8968-4cfcee2f87bb
Almudarra, S.
d3f312a4-5d1b-4dc5-afbc-822361f1aaf9
Rutherford, M.J.
9bdb6f34-dccd-48ce-853d-2c54efc51d0a
Dondo, T.B.
d62bfcb2-ae5b-418a-b44f-dd4098660398
Feltbower, R.
efada5d7-ce80-425b-b864-3adff22b58ed
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
de Belder, M.
3db05f9a-feec-4c2c-959e-19a3029e24c0
Ludman, P.
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Gale, C.P.
5bb2abb3-7b53-42d6-8aa7-817e193140c8
National Institute for Cardiovascular Outcomes Research
Alabas, O.A.
1365daa2-c294-46f3-9bc4-32487ba25c27
Brogan, R.A.
f24beefd-9692-4f9f-a1a9-db1289fa84ff
Hall, M.
b813c2f9-7a95-4fe1-8968-4cfcee2f87bb
Almudarra, S.
d3f312a4-5d1b-4dc5-afbc-822361f1aaf9
Rutherford, M.J.
9bdb6f34-dccd-48ce-853d-2c54efc51d0a
Dondo, T.B.
d62bfcb2-ae5b-418a-b44f-dd4098660398
Feltbower, R.
efada5d7-ce80-425b-b864-3adff22b58ed
Curzen, N.
70f3ea49-51b1-418f-8e56-8210aef1abf4
de Belder, M.
3db05f9a-feec-4c2c-959e-19a3029e24c0
Ludman, P.
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Gale, C.P.
5bb2abb3-7b53-42d6-8aa7-817e193140c8

Alabas, O.A., Brogan, R.A., Hall, M., Almudarra, S., Rutherford, M.J., Dondo, T.B., Feltbower, R., Curzen, N., de Belder, M., Ludman, P. and Gale, C.P. , National Institute for Cardiovascular Outcomes Research (2016) Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention. Heart, 102 (16), 1287-1295. (doi:10.1136/heartjnl-2015-308739).

Record type: Article

Abstract

OBJECTIVE: For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality.

METHODS: A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI-CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56.6 million people. Relative survival and excess mortality were estimated.

RESULTS: Over 26 105 person-years follow-up, crude 5-year relative survival was 93.8% for CSA, 73.1% for NSTEACS, 77.5% for STEMI-CS and 28.5% for STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73, 95% CI 4.06 to 11.15), and for NSTEACS and STEMI-CS was preprocedural ventilation (6.25, 5.05 to 7.75 and 6.92, 4.25 to 11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural thrombolysis in myocardial infarction (TIMI) 0 flow (2.78, 1.87 to 4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61 to 0.90).

CONCLUSIONS: Long-term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI-CS, the requirement for preprocedural ventilation was the strongest determinant of excess mortality. By contrast, among STEMI+CS, in whom survival was poor, the strongest determinant was preprocedural TIMI flow. Future cardiovascular cohort studies of long-term mortality should consider the impact of non-cardiovascular deaths.

Full text not available from this repository.

More information

Accepted/In Press date: 9 March 2016
e-pub ahead of print date: 7 April 2016
Additional Information: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Keywords: Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Angina, Stable/diagnosis, Cause of Death, Comorbidity, Coronary Artery Disease/diagnosis, Coronary Circulation, Female, Humans, Male, Middle Aged, Non-ST Elevated Myocardial Infarction/diagnosis, Percutaneous Coronary Intervention/adverse effects, Registries, Respiration, Artificial/adverse effects, Risk Assessment, Risk Factors, ST Elevation Myocardial Infarction/diagnosis, Sex Factors, Survivors, Time Factors, Treatment Outcome, United Kingdom/epidemiology, Young Adult

Identifiers

Local EPrints ID: 435850
URI: http://eprints.soton.ac.uk/id/eprint/435850
ISSN: 1355-6037
PURE UUID: 971e5ed7-a906-4faa-9cac-ad0f02ddf0fc
ORCID for C.P. Gale: ORCID iD orcid.org/0000-0002-3361-8638

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Date deposited: 21 Nov 2019 17:30
Last modified: 17 Dec 2019 01:59

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Contributors

Author: O.A. Alabas
Author: R.A. Brogan
Author: M. Hall
Author: S. Almudarra
Author: M.J. Rutherford
Author: T.B. Dondo
Author: R. Feltbower
Author: N. Curzen
Author: M. de Belder
Author: P. Ludman
Author: C.P. Gale ORCID iD

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