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. 2016 Apr 15;3(1):e000405.
doi: 10.1136/openhrt-2016-000405. eCollection 2016.

Mortality pattern and cause of death in a long-term follow-up of patients with STEMI treated with primary PCI

Ataollah Doost Hosseiny  1 , Soniah Moloi  1 , Jaya Chandrasekhar  2 , Ahmad Farshid  3
Affiliations

Mortality pattern and cause of death in a long-term follow-up of patients with STEMI treated with primary PCI

Ataollah Doost Hosseiny et al. Open Heart. .

Abstract

Objective: We aimed to assess the pattern of mortality and cause of death in a cohort of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Methods: Consecutive patients with STEMI treated with primary PCI during 2006-2013 were evaluated with a mean follow-up of 3.5 years (1-8.4 years). We used hospital and general practice records and mortality data from The Australian National Death Index.

Results: Among 1313 patients (22.5% female) with mean age of 62.3±13.1 years, 181 patients (13.7%) died during long-term follow-up. In the first 7 days, 45 patients (3.4%) died, 76% of these due to cardiogenic shock. Between 7 days and 1 year, another 50 patients died (3.9%), 58% from cardiovascular causes and 22% from cancer. Beyond 1 year, there were 86 deaths with an estimated mean mortality rate of 2.05% per year, 36% of deaths were cardiovascular and 52% non-cardiovascular, including 29% cancer-related deaths. On multivariate analysis, age ≥75 years, history of diabetes, prior PCI, cardiogenic shock, estimated glomerular filtration rate (eGFR) <60 and symptom-to-balloon time >360 min were independent predictors of long-term mortality. In 16 patients who died of sudden cardiac death postdischarge, only 4 (25%) had ejection fraction ≤35% and would have been eligible for an implantable cardioverter defibrillator.

Conclusions: In the era of routine primary PCI, we found a mortality rate of 7.3% at 1 year, and 2.05% per year thereafter. Cause of death was predominantly cardiovascular in the first year and mainly non-cardiovascular after 1 year. Age, diabetes, prior PCI, cardiogenic shock, eGFR <60 and delayed treatment were independent predictors of mortality.

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Figures

Figure 1
Figure 1
Kaplan–Meyer survival curve of 1313 patients following primary PCI. The main figure shows survival to 900 days, and the smaller figure shows survival to 30 days. PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Percentage of mortality from cardiovascular or non-cardiovascular causes during specified phases after primary PCI. PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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