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https://hdl.handle.net/2440/116175
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Type: | Journal article |
Title: | Trends in cause of death after percutaneous coronary intervention |
Author: | Spoon, D. Psaltis, P. Singh, M. Holmes, D. Gersh, B. Rihal, C. Lennon, R. Moussa, I. Simari, R. Gulati, R. |
Citation: | Circulation, 2014; 129(12):1286-1294 |
Publisher: | American Heart Association |
Issue Date: | 2014 |
ISSN: | 0009-7322 1524-4539 |
Statement of Responsibility: | Daniel B. Spoon, Peter J. Psaltis, Mandeep Singh, David R. Holmes Jr, Bernard J. Gersh, Charanjit S. Rihal, Ryan J. Lennon, Issam D. Moussa, Robert D. Simari, Rajiv Gulati |
Abstract: | BACKGROUND: The impact of changing demographics on causes of long-term death after percutaneous coronary intervention (PCI) remains incompletely defined. METHODS AND RESULTS: We evaluated trends in cause-specific long-term mortality after index PCI performed at a single center from 1991 to 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 3 time periods of PCI (1991-1996, 1997-2002, and 2003-2008). Final follow-up was December 31, 2012. A total of 19 077 patients survived index PCI hospitalization, of whom 6988 subsequently died (37%, 4.48 per 100 person-years). Cause was determined in 6857 (98.1%). Across 3 time periods, there was a 33% decline in cardiac deaths at 5 years after PCI (incidence: 9.8%, 7.4%, and 6.6%) but a 57% increase in noncardiac deaths (7.1%, 8.5%, and 11.2%). Only 36.8% of deaths in the recent era were cardiac. Similar trends were observed regardless of age, extent of coronary disease, or PCI indication. 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 not heart failure (P=0.85). The increase in noncardiac mortality was primarily attributable to cancer and chronic diseases (P<0.001). CONCLUSIONS: This study found a marked temporal switch from predominantly cardiac to predominantly noncardiac causes of death after PCI over 2 decades. The decline in cardiac mortality was independent of changes in baseline clinical characteristics. These findings have implications for patient care and clinical trial design. |
Keywords: | Death; cardiovascular diseases; percutaneous coronary intervention; coronary disease |
Rights: | © 2014 American Heart Association, Inc. |
DOI: | 10.1161/CIRCULATIONAHA.113.006518 |
Published version: | http://dx.doi.org/10.1161/circulationaha.113.006518 |
Appears in Collections: | Aurora harvest 8 Public Health publications |
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