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Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention.
- Source :
- Heart; 8/15/2016, Vol. 102 Issue 16, p1287-1295, 9p, 1 Diagram, 2 Charts, 4 Graphs
- Publication Year :
- 2016
-
Abstract
- <bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- MYOCARDIAL infarction
MYOCARDIAL infarction diagnosis
PERCUTANEOUS coronary intervention
PATIENTS
ANGINA pectoris treatment
DIAGNOSIS
CORONARY heart disease treatment
AGE distribution
ANGINA pectoris
ARTIFICIAL respiration
CARDIOVASCULAR system
CORONARY circulation
CORONARY disease
CAUSES of death
MEDICAL care
RESEARCH funding
RISK assessment
SEX distribution
TIME
COMORBIDITY
TREATMENT effectiveness
ACQUISITION of data
Subjects
Details
- Language :
- English
- ISSN :
- 13556037
- Volume :
- 102
- Issue :
- 16
- Database :
- Complementary Index
- Journal :
- Heart
- Publication Type :
- Academic Journal
- Accession number :
- 117068586
- Full Text :
- https://doi.org/10.1136/heartjnl-2015-308739