Brogan, RA, Alabas, O, Almudarra, S et al. (9 more authors) (2019) Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. European Heart Journal: Acute Cardiovascular Care, 8 (1). pp. 68-77. ISSN 2048-8726
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The European Society of Cardiology 2017. Brogan, RA, Alabas, O, Almudarra, S et al. (9 more authors) (2019) Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. European Heart Journal: Acute Cardiovascular Care, 8 (1). pp. 68-77. ISSN 2048-8726. Reprinted by permission of SAGE Publications. |
Keywords: | Primary percutaneous coronary intervention; ST-elevation myocardial infarction; relative survival; excess mortality; cardiogenic shock; renal insufficiency; radial access; risk stratification |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Specialist Science Education Dept (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 01 Mar 2019 10:31 |
Last Modified: | 25 Jun 2023 21:44 |
Status: | Published |
Publisher: | SAGE |
Identification Number: | 10.1177/2048872617710790 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:143128 |