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Title: Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes?
Austin Authors: Biswas, Sinjini;Andrianopoulos, Nick;Papapostolou, Stavroula;Noaman, Samer;Duffy, Stephen J;Lefkovits, Jeffrey;Brennan, Angela;Walton, Antony;Shaw, James A;Ajani, Andrew;Clark, David J ;Freeman, Melanie;Hiew, Chin;Oqueli, Ernesto;Reid, Christopher M;Stub, Dion;Chan, William
Affiliation: Department of Medicine, Monash University, Melbourne, Australia
School of Public Health, Curtin University, Perth, Australia
Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Medicine, University of Melbourne, Melbourne, Australia
Department of Cardiology, Box Hill Hospital, Melbourne, Australia
Department of Cardiology, University Hospital Geelong, Geelong, Australia
Department of Cardiology, Ballarat Health Services, Ballarat, Australia
School of Medicine, Deakin University, Ballarat, Australia
Issue Date: 21-Mar-2018
Date: 2018-10-01
Publication information: European Heart Journal. Quality of Care & Clinical Outcomes 2018; 4(4): 318-327
Abstract: The prognosis of patients undergoing percutaneous coronary intervention (PCI) for different subtypes of acute coronary syndromes (ACS) remains unclear. We compared short- and long-term mortality in patients undergoing PCI for unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). This was a retrospective cohort study of 13 184 patients (5966 STEMI, 5307 NSTEMI, and 1911 UA) undergoing PCI between 1 January 2005 and 30 November 2013 in a multi-centre registry. Clinical and procedural characteristics, as well as outcomes, were compared by ACS subtype. Long-term all-cause mortality data were obtained via linkage to the National Death Index (NDI). Patients with STEMI compared with NSTEMI and UA were younger (62.9 ± 12.8 vs. 64.7 ± 12.5 vs. 65.5 ± 11.8 years; P < 0.01), had fewer comorbidities including diabetes, heart failure, and previous myocardial infarction (all P < 0.01). Procedural success was similar across all groups (P = 0.54). In-hospital, 30-day and 1-year all-cause mortality increased significantly from UA to NSTEMI to STEMI patients (1-year mortality 2.5% vs. 4.5% vs. 8.7%; P < 0.01). Kaplan-Meier survival estimates showed increased early mortality in the STEMI group (log-rank P < 0.01). However, after approximately 8.2 years, survival was similar across all groups. In a proportional-odds model using flexible parametric survival modelling, ACS subtype was not an independent predictor of NDI-linked mortality [UA: odds ratio (OR) 0.85, 95% CI 0.71-1.02; STEMI: OR 1.01, 95% confidence interval (CI) 0.88-1.16; NSTEMI as reference category]. Despite disparate baseline characteristics and differences in short-term mortality, long-term mortality was similar across the spectrum of ACS treated by PCI and contemporary medical therapy.
DOI: 10.1093/ehjqcco/qcy009
Journal: European Heart Journal. Quality of Care & Clinical Outcomes
PubMed URL: 30124800
Type: Journal Article
Appears in Collections:Journal articles

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