Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction

Richard A. Brogan; Oras Alabas; Sami Almudarra; Marlous Hall; Tatendashe B. Dondo; Mamas A. Mamas; Paul D. Baxter; Phillip D. Batin; Nick Curzen; Mark de Belder; Peter F. Ludman; Chris P. Gale

doi:10.1177/2048872617710790

Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction

Richard A. Brogan, Oras Alabas, Sami Almudarra, Marlous Hall, Tatendashe B. Dondo, Mamas A. Mamas, Paul D. Baxter, Phillip D. Batin, Nick Curzen, Mark de Belder, Peter F. Ludman, Chris P. Gale

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Abstract

BACKGROUND:: High survival rates are commonly reported following primary percutaneous coronary intervention for ST-elevation myocardial infarction, with most contemporary studies reporting overall survival. AIMS:: The aim of this study was to describe survival following primary percutaneous coronary intervention for ST-elevation myocardial infarction corrected for non-cardiovascular deaths by reporting relative survival and investigate clinically significant factors associated with poor long-term outcomes. METHODS AND RESULTS:: Using the prospective UK Percutaneous Coronary Intervention registry, primary percutaneous coronary intervention cases ( n=88,188; 2005-2013) were matched to mortality data for the UK populace. Crude five-year relative survival was 87.1% for the patients undergoing primary percutaneous coronary intervention and 94.7% for patients 75 years: 4.69, 4.27-5.16). After four years, there was no excess mortality for ages 56-65 years (excess mortality rate ratio 1.27, 0.95-1.70), but persisting excess mortality for older groups (66-75 years: excess mortality rate ratio 1.72, 1.30-2.27; >75 years: 1.66, 1.15-2.41). Excess mortality was associated with cardiogenic shock (excess mortality rate ratio 6.10, 5.72-6.50), renal failure (2.52, 2.27-2.81), left main stem stenosis (1.67, 1.54-1.81), diabetes (1.58, 1.47-1.69), previous myocardial infarction (1.52, 1.40-1.65) and female sex (1.33, 1.26-1.41); whereas stent deployment (0.46, 0.42-0.50) especially drug eluting stents (0.27, 0.45-0.55), radial access (0.70, 0.63-0.71) and previous percutaneous coronary intervention (0.67, 0.60-0.75) were protective. CONCLUSIONS:: Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, long-term cardiovascular survival is excellent. Failure to account for non-cardiovascular death may result in an underestimation of the efficacy of primary percutaneous coronary intervention.

Original language	English
Pages (from-to)	68-77
Number of pages	10
Journal	European heart journal. Acute cardiovascular care
Volume	8
Issue number	1
DOIs	https://doi.org/10.1177/2048872617710790
Publication status	Published - 1 Feb 2019

Keywords

Primary percutaneous coronary intervention
ST-elevation myocardial infarction
cardiogenic shock
excess mortality
radial access
relative survival
renal insufficiency
risk stratification

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Brogan, R. A., Alabas, O., Almudarra, S., Hall, M., Dondo, T. B., Mamas, M. A., Baxter, P. D., Batin, P. D., Curzen, N., de Belder, M., Ludman, P. F., & Gale, C. P. (2019). Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. European heart journal. Acute cardiovascular care, 8(1), 68-77. https://doi.org/10.1177/2048872617710790

@article{5a906685ae694317b554c9ab4fde1ea0,

title = "Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction",

abstract = "BACKGROUND:: High survival rates are commonly reported following primary percutaneous coronary intervention for ST-elevation myocardial infarction, with most contemporary studies reporting overall survival. AIMS:: The aim of this study was to describe survival following primary percutaneous coronary intervention for ST-elevation myocardial infarction corrected for non-cardiovascular deaths by reporting relative survival and investigate clinically significant factors associated with poor long-term outcomes. METHODS AND RESULTS:: Using the prospective UK Percutaneous Coronary Intervention registry, primary percutaneous coronary intervention cases ( n=88,188; 2005-2013) were matched to mortality data for the UK populace. Crude five-year relative survival was 87.1% for the patients undergoing primary percutaneous coronary intervention and 94.7% for patients 75 years: 4.69, 4.27-5.16). After four years, there was no excess mortality for ages 56-65 years (excess mortality rate ratio 1.27, 0.95-1.70), but persisting excess mortality for older groups (66-75 years: excess mortality rate ratio 1.72, 1.30-2.27; >75 years: 1.66, 1.15-2.41). Excess mortality was associated with cardiogenic shock (excess mortality rate ratio 6.10, 5.72-6.50), renal failure (2.52, 2.27-2.81), left main stem stenosis (1.67, 1.54-1.81), diabetes (1.58, 1.47-1.69), previous myocardial infarction (1.52, 1.40-1.65) and female sex (1.33, 1.26-1.41); whereas stent deployment (0.46, 0.42-0.50) especially drug eluting stents (0.27, 0.45-0.55), radial access (0.70, 0.63-0.71) and previous percutaneous coronary intervention (0.67, 0.60-0.75) were protective. CONCLUSIONS:: Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, long-term cardiovascular survival is excellent. Failure to account for non-cardiovascular death may result in an underestimation of the efficacy of primary percutaneous coronary intervention.",

keywords = "Primary percutaneous coronary intervention, ST-elevation myocardial infarction, cardiogenic shock, excess mortality, radial access, relative survival, renal insufficiency, risk stratification",

author = "Brogan, {Richard A.} and Oras Alabas and Sami Almudarra and Marlous Hall and Dondo, {Tatendashe B.} and Mamas, {Mamas A.} and Baxter, {Paul D.} and Batin, {Phillip D.} and Nick Curzen and {de Belder}, Mark and Ludman, {Peter F.} and Gale, {Chris P.}",

year = "2019",

month = feb,

day = "1",

doi = "10.1177/2048872617710790",

language = "English",

volume = "8",

pages = "68--77",

journal = "European heart journal. Acute cardiovascular care",

issn = "2048-8726",

publisher = "Sage Publications Ltd",

number = "1",

}

Brogan, RA, Alabas, O, Almudarra, S, Hall, M, Dondo, TB, Mamas, MA, Baxter, PD, Batin, PD, Curzen, N, de Belder, M, Ludman, PF & Gale, CP 2019, 'Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction', European heart journal. Acute cardiovascular care, vol. 8, no. 1, pp. 68-77. https://doi.org/10.1177/2048872617710790

TY - JOUR

T1 - Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction

AU - Brogan, Richard A.

AU - Alabas, Oras

AU - Almudarra, Sami

AU - Hall, Marlous

AU - Dondo, Tatendashe B.

AU - Mamas, Mamas A.

AU - Baxter, Paul D.

AU - Batin, Phillip D.

AU - Curzen, Nick

AU - de Belder, Mark

AU - Ludman, Peter F.

AU - Gale, Chris P.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - BACKGROUND:: High survival rates are commonly reported following primary percutaneous coronary intervention for ST-elevation myocardial infarction, with most contemporary studies reporting overall survival. AIMS:: The aim of this study was to describe survival following primary percutaneous coronary intervention for ST-elevation myocardial infarction corrected for non-cardiovascular deaths by reporting relative survival and investigate clinically significant factors associated with poor long-term outcomes. METHODS AND RESULTS:: Using the prospective UK Percutaneous Coronary Intervention registry, primary percutaneous coronary intervention cases ( n=88,188; 2005-2013) were matched to mortality data for the UK populace. Crude five-year relative survival was 87.1% for the patients undergoing primary percutaneous coronary intervention and 94.7% for patients 75 years: 4.69, 4.27-5.16). After four years, there was no excess mortality for ages 56-65 years (excess mortality rate ratio 1.27, 0.95-1.70), but persisting excess mortality for older groups (66-75 years: excess mortality rate ratio 1.72, 1.30-2.27; >75 years: 1.66, 1.15-2.41). Excess mortality was associated with cardiogenic shock (excess mortality rate ratio 6.10, 5.72-6.50), renal failure (2.52, 2.27-2.81), left main stem stenosis (1.67, 1.54-1.81), diabetes (1.58, 1.47-1.69), previous myocardial infarction (1.52, 1.40-1.65) and female sex (1.33, 1.26-1.41); whereas stent deployment (0.46, 0.42-0.50) especially drug eluting stents (0.27, 0.45-0.55), radial access (0.70, 0.63-0.71) and previous percutaneous coronary intervention (0.67, 0.60-0.75) were protective. CONCLUSIONS:: Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, long-term cardiovascular survival is excellent. Failure to account for non-cardiovascular death may result in an underestimation of the efficacy of primary percutaneous coronary intervention.

AB - BACKGROUND:: High survival rates are commonly reported following primary percutaneous coronary intervention for ST-elevation myocardial infarction, with most contemporary studies reporting overall survival. AIMS:: The aim of this study was to describe survival following primary percutaneous coronary intervention for ST-elevation myocardial infarction corrected for non-cardiovascular deaths by reporting relative survival and investigate clinically significant factors associated with poor long-term outcomes. METHODS AND RESULTS:: Using the prospective UK Percutaneous Coronary Intervention registry, primary percutaneous coronary intervention cases ( n=88,188; 2005-2013) were matched to mortality data for the UK populace. Crude five-year relative survival was 87.1% for the patients undergoing primary percutaneous coronary intervention and 94.7% for patients 75 years: 4.69, 4.27-5.16). After four years, there was no excess mortality for ages 56-65 years (excess mortality rate ratio 1.27, 0.95-1.70), but persisting excess mortality for older groups (66-75 years: excess mortality rate ratio 1.72, 1.30-2.27; >75 years: 1.66, 1.15-2.41). Excess mortality was associated with cardiogenic shock (excess mortality rate ratio 6.10, 5.72-6.50), renal failure (2.52, 2.27-2.81), left main stem stenosis (1.67, 1.54-1.81), diabetes (1.58, 1.47-1.69), previous myocardial infarction (1.52, 1.40-1.65) and female sex (1.33, 1.26-1.41); whereas stent deployment (0.46, 0.42-0.50) especially drug eluting stents (0.27, 0.45-0.55), radial access (0.70, 0.63-0.71) and previous percutaneous coronary intervention (0.67, 0.60-0.75) were protective. CONCLUSIONS:: Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, long-term cardiovascular survival is excellent. Failure to account for non-cardiovascular death may result in an underestimation of the efficacy of primary percutaneous coronary intervention.

KW - Primary percutaneous coronary intervention

KW - ST-elevation myocardial infarction

KW - cardiogenic shock

KW - excess mortality

KW - radial access

KW - relative survival

KW - renal insufficiency

KW - risk stratification

U2 - 10.1177/2048872617710790

DO - 10.1177/2048872617710790

M3 - Article

C2 - 28691534

VL - 8

SP - 68

EP - 77

JO - European heart journal. Acute cardiovascular care

JF - European heart journal. Acute cardiovascular care

SN - 2048-8726

IS - 1

ER -

Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction

Abstract

Keywords

UN SDGs

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