Trends in Cause of Death After Percutaneous Coronary Intervention

Study Questions:

How has cause of long-term death changed in patients undergoing percutaneous coronary intervention (PCI)?

Methods:

The authors assessed trends in cause-specific long-term mortality after index PCI performed at the Mayo Clinic from 1991-2008. Deaths were ascertained by scheduled prospective surveillance. Cause was determined via telephone interviews, medical records, autopsy reports, and death certificates. Competing-risks analysis of cause-specific mortality was performed using three time periods of PCI (1991-1996, 1997-2002, and 2003-2008).

Results:

Cause of death was determined in 6,857 (98.1%) patients. Cardiac mortality at 5 years declined across the time period from 9.8%, to 7.4%, to 6.6%, whereas noncardiac mortality increased (7.1%, 8.5%, 11.2%). Only 36.8% of deaths in the recent era were cardiac. After adjustment for baseline variables, there was a 50% temporal decline in cardiac mortality, but no change in noncardiac mortality. The decline in cardiac mortality was driven by fewer deaths from myocardial infarction/sudden death (p < 0.001), but no difference in heart failure deaths was noted (p = 0.85). The increase in noncardiac mortality was due primarily to cancer and chronic diseases (p < 0.001).

Conclusions:

The authors concluded that long-term mortality after PCI is increasingly from noncardiac causes, with a significant decline in death from cardiac causes.

Perspective:

This study demonstrates the impact secondary prevention has had on outcome of patients undergoing PCI. Better risk factor control would be expected to translate into a reduction in cardiac mortality, and this study confirms that. About one third of deaths are still from cardiac causes, and it is possible that some of these could be potentially prevented. However, it is equally likely that such a reduction would be offset by an increase in death from noncardiac causes. Efforts to improve survival after PCI need to focus on all-cause mortality and on improving both cardiac as well as noncardiac health.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Cause of Death, Risk Assessment, Angioplasty, Balloon, Coronary, Medical Records, Percutaneous Coronary Intervention


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