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Multicenter Study
. 2019 Feb;8(1):68-77.
doi: 10.1177/2048872617710790. Epub 2017 Jul 10.

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

Richard A Brogan  1 , Oras Alabas  1 , Sami Almudarra  1 , Marlous Hall  1 , Tatendashe B Dondo  1 , Mamas A Mamas  2 , Paul D Baxter  1 , Phillip D Batin  3 , Nick Curzen  4 , Mark de Belder  5 , Peter F Ludman  6 , Chris P Gale  1   7
Affiliations
Multicenter Study

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

Richard A Brogan et al. Eur Heart J Acute Cardiovasc Care. 2019 Feb.

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.

Keywords: Primary percutaneous coronary intervention; ST-elevation myocardial infarction; cardiogenic shock; excess mortality; radial access; relative survival; renal insufficiency; risk stratification.

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Conflict of interest statement

Conflicts of interest statement

RAB, OA, MH, SA, TBD, MM, PDB, PB, MdB, and PL have no conflicts of interest. CPG has received consultancy and speaker bureau fees from AstraZeneca and Novartis. NC has received unrestricted research grants from Medtronic, Haemonetics, Boston Scientific, St Jude Medical, Heartflow; honoraria from St Jude Medical, Heartflow; unrestricted education grant from Volcano.

Figures

Figure 1
Figure 1. STROBE diagram of data flow
Figure 2
Figure 2. Five year relative survival following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI), stratified by age.
CI: Confidence interval.
Figure 3
Figure 3. 3 Factors associated with excess mortality following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI).
CAD: coronary artery disease; CI: confidence interval; LMS: left main stem coronary artery; MI: myocardial infarction; PCI: percutaneous coronary intervention
See this image and copyright information in PMC

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