Please use this identifier to cite or link to this item: http://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.
RMID: 0030063176
DOI: 10.1161/CIRCULATIONAHA.113.006518
Appears in Collections:Public Health publications

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