What is the Long-Term Cause of Death in STEMI Patients Treated With Primary PCI?

The risk of cardiac mortality declines to less than 1.5 percent per year following survival after a ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), and noncardiac causes are responsible for the majority of later deaths in these patients, according to a study published Nov. 10 in the Journal of the American College of Cardiology.

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The study looked at 2,804 patients treated with PCI from July 1998 to July 2008. Researchers followed patients for a median of 4.7 years after the procedure. Results showed that cardiac-related death was high during the first month following treatment – with cardiogenic shock and anoxic brain injury after cardiac arrest as the main causes of death – but fell significantly after 30 days to an annual rate of less than 1.5 percent. While the “cardiac prognosis was excellent,” the causes of death after a month were noncardiac nearly 65 percent of the time. The risk factors that contributed to the initial heart attack were superseded by others, putting the patient at higher risk of future noncardiac events such as cancer and lung conditions.

“The very low long-term cardiac death rate might be explained to some extent by secondary prevention programs,” said Frants Pedersen, MD, PhD, of Rigshospitalet at the University of Copenhagen and lead author of the study. “How non-cardiovascular death is influenced by cardiovascular disease needs further study. Our findings encourage continued concentration of resources in prevention and particularly the treatment of patients in the early phases of a heart attack. Medical professionals should not only look at the factors that put the patient at risk for a heart attack but also work to prevent noncardiac diseases on top of the secondary prevention towards cardiac events after a PCI.”

In an accompanying editorial comment, Mark Hlatky, MD, FACC, of Stanford University School of Medicine, said the study indicates clinicians should take a holistic view of patients. “The reduction in mortality from primary PCI can only be a short-term success, and in the long-term, other forces of mortality will come to the fore. We need to recognize the factors, both cardiac and noncardiac, that pose the greatest risk to patients who survive a myocardial infarction, and initiate the therapies and behavior changes that will reduce the risk of late mortality.”

Keywords: Cause of Death, Shock, Cardiogenic, Risk, Myocardial Infarction, Neoplasms, Brain Injuries, Heart Arrest, Percutaneous Coronary Intervention

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