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Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris.
Am J Cardiol. 2009 Aug 01; 104(3):333-7.AJ

Abstract

Data remain limited regarding the comparative long-term mortality across the spectrum of patients with different indications for percutaneous coronary intervention (PCI). We evaluated early and late mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI compared with early and late mortality in patients undergoing PCI for unstable angina (UA) or non-STEMI (NSTEMI) and stable angina. A total of 10,549 consecutive patients undergoing PCI from 1997 to 2005 at a single institution were followed up prospectively (median 3.2 years, interquartile range 1.5 to 5.6) to assess all-cause mortality. The indication for PCI was STEMI in 28%, UA/NSTEMI in 32%, and stable angina in 40%. The mortality rate at 6 years was 18.9% in patients with STEMI, 16.2% in patients with UA/NSTEMI, and 11.7% in those with stable angina. During the initial 6 months, patients with STEMI had an increased risk of death compared with patients with UA/NSTEMI (relative risk [RR] 3.09, 95% confidence interval [CI] 2.46 to 3.89) and stable angina (RR 5.82, 95% CI 4.45 to 7.62). However, between 6 months and 6 years, mortality accrued at an almost similar rate among patients with STEMI and those with stable angina (RR 1.06, 95% CI 0.86 to 1.32) and mortality was greatest in patients with UA/NSTEMI (UA/NSTEMI vs stable angina: RR 1.33, 95% CI 1.11 to 1.58; STEMI vs UA/NSTEMI: RR 0.80, 95% CI 0.65 to 0.99). In conclusion, we have demonstrated that the inferior survival rates in patients with STEMI after primary PCI are mainly attributed to greater mortality in the first months after the event. These observations highlight that new adjunctive therapeutic strategies should aim at mortality reduction in the first months after primary PCI.

Authors+Show Affiliations

Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands. a.hirsch@amc.uva.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19616663

Citation

Hirsch, Alexander, et al. "Comparison of Long-term Mortality After Percutaneous Coronary Intervention in Patients Treated for Acute ST-elevation Myocardial Infarction Versus Those With Unstable and Stable Angina Pectoris." The American Journal of Cardiology, vol. 104, no. 3, 2009, pp. 333-7.
Hirsch A, Verouden NJ, Koch KT, et al. Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris. Am J Cardiol. 2009;104(3):333-7.
Hirsch, A., Verouden, N. J., Koch, K. T., Baan, J., Henriques, J. P., Piek, J. J., Rohling, W. J., van der Schaaf, R. J., Tijssen, J. G., Vis, M. M., & de Winter, R. J. (2009). Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris. The American Journal of Cardiology, 104(3), 333-7. https://doi.org/10.1016/j.amjcard.2009.03.052
Hirsch A, et al. Comparison of Long-term Mortality After Percutaneous Coronary Intervention in Patients Treated for Acute ST-elevation Myocardial Infarction Versus Those With Unstable and Stable Angina Pectoris. Am J Cardiol. 2009 Aug 1;104(3):333-7. PubMed PMID: 19616663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris. AU - Hirsch,Alexander, AU - Verouden,Niels J W, AU - Koch,Karel T, AU - Baan,Jan,Jr AU - Henriques,José P S, AU - Piek,Jan J, AU - Rohling,Wim J, AU - van der Schaaf,Rene J, AU - Tijssen,Jan G P, AU - Vis,Marije M, AU - de Winter,Robbert J, Y1 - 2009/06/06/ PY - 2008/12/17/received PY - 2009/03/21/revised PY - 2009/03/21/accepted PY - 2009/7/21/entrez PY - 2009/7/21/pubmed PY - 2009/9/1/medline SP - 333 EP - 7 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 104 IS - 3 N2 - Data remain limited regarding the comparative long-term mortality across the spectrum of patients with different indications for percutaneous coronary intervention (PCI). We evaluated early and late mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI compared with early and late mortality in patients undergoing PCI for unstable angina (UA) or non-STEMI (NSTEMI) and stable angina. A total of 10,549 consecutive patients undergoing PCI from 1997 to 2005 at a single institution were followed up prospectively (median 3.2 years, interquartile range 1.5 to 5.6) to assess all-cause mortality. The indication for PCI was STEMI in 28%, UA/NSTEMI in 32%, and stable angina in 40%. The mortality rate at 6 years was 18.9% in patients with STEMI, 16.2% in patients with UA/NSTEMI, and 11.7% in those with stable angina. During the initial 6 months, patients with STEMI had an increased risk of death compared with patients with UA/NSTEMI (relative risk [RR] 3.09, 95% confidence interval [CI] 2.46 to 3.89) and stable angina (RR 5.82, 95% CI 4.45 to 7.62). However, between 6 months and 6 years, mortality accrued at an almost similar rate among patients with STEMI and those with stable angina (RR 1.06, 95% CI 0.86 to 1.32) and mortality was greatest in patients with UA/NSTEMI (UA/NSTEMI vs stable angina: RR 1.33, 95% CI 1.11 to 1.58; STEMI vs UA/NSTEMI: RR 0.80, 95% CI 0.65 to 0.99). In conclusion, we have demonstrated that the inferior survival rates in patients with STEMI after primary PCI are mainly attributed to greater mortality in the first months after the event. These observations highlight that new adjunctive therapeutic strategies should aim at mortality reduction in the first months after primary PCI. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/19616663/Comparison_of_long_term_mortality_after_percutaneous_coronary_intervention_in_patients_treated_for_acute_ST_elevation_myocardial_infarction_versus_those_with_unstable_and_stable_angina_pectoris_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(09)00814-5 DB - PRIME DP - Unbound Medicine ER -