Among patients undergoing primary PCI for STEMI, the 10-year all-cause mortality rate was 35.3%, with non-cardiovascular deaths significantly outnumbering cardiovascular deaths after the first year.
Cohort (n=691)
No
What are the 10-year mortality rates, modes of death, and predictors of mortality in patients treated with primary PCI for STEMI?
In patients undergoing primary PCI for STEMI, 10-year mortality is substantial (35.3%), with the mode of death shifting from predominantly cardiovascular in the first year to predominantly non-cardiovascular in the subsequent 9 years.
Abstract Background Primary percutaneous coronary intervention (PPCI) is the standard of care for the treatment of ST elevation myocardial infarction (STEMI) but there are few long term studies of clinical outcomes in patients treated with PPCI (1). Purpose To analyse the 10-year outcomes of a population of patients treated with PPCI for STEMI, with a focus on mortality rates as well as the modes and predictors of death. Methods We identified all patients treated with PPCI in our Heart Attack Centre during 2014. We extracted clinical information covering the subsequent 10 years from the Regional Electronic Care Record. We used Kaplan-Meier time-to-event analysis to estimate the cumulative incidence of death. We constructed a Cox proportional hazards regression model to calculate hazard ratios for independent predictors of mortality. Data were analysed using SPSS v.28.0. Results Six-hundred and ninety-one patients (mean age 64 +/- SD13 years; 25.4% female) who underwent PPCI during 2014 were followed for a median of 10.5 years. Comprehensive clinical information was available for every patient. All-cause mortality was 6.9% after 30 days, 7.8% after 1 year and 35.3% after 10 years. Age, prolonged door-to-balloon time, pre-existing cardiovascular, lung or kidney disease and diabetes mellitus were all independent predictors of 10-year mortality. Modes of death (cardiovascular versus non-cardiovascular) are shown in the Figure. After excluding 28 patients in whom the cause of death was uncertain, cardiovascular deaths outnumbered non-cardiovascular deaths during the first year after PPCI (5.8% vs 1.6%; χ2=50.0, P0.001). During the subsequent 9 years, there was a significant preponderance of non-cardiovascular deaths (21.1% vs 5.9%; χ2=10.2, P=0.001). Over all, non-cardiovascular deaths considerably outnumbered cardiovascular deaths after 10 years. Conclusions The 10-year mortality rate among unselected patients undergoing PPCI for STEMI was 35.3%. Non-cardiovascular causes of death were substantially commoner than cardiovascular causes, with a clear disparity between the first year and the subsequent 9 years of follow-up.
Savage et al. (Sat,) conducted a cohort in ST elevation myocardial infarction (STEMI) (n=691). Primary percutaneous coronary intervention (PPCI) was evaluated on 10-year all-cause mortality. Among patients undergoing primary PCI for STEMI, the 10-year all-cause mortality rate was 35.3%, with non-cardiovascular deaths significantly outnumbering cardiovascular deaths after the first year.