Key result
Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, crude five-year relative survival was 87.1%, indicating excellent long-term cardiovascular survival.
Why the study?
What is the long-term relative survival and what factors are associated with excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction?
Cohort (n=88,188)
Yes
What is the long-term relative survival and what factors are associated with excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction?
Accounting for non-cardiovascular death reveals excellent long-term cardiovascular survival following primary PCI for STEMI, with excess mortality primarily driven by advanced age and specific comorbidities such as cardiogenic shock and renal failure.
Answers are grounded in this paper and cite their sources.
Supports excellent long-term survival after pPCI for STEMI in registries; extends prior data but leaves open generalizability to broader populations.
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 <55 years. Increasing age was associated with excess mortality up to four years following primary percutaneous coronary intervention (56-65 years: excess mortality rate ratio 1.61, 95% confidence interval 1.46-1.79; 66-75 years: 2.49, 2.26-2.75; >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.
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Brogan et al. (2017) conducted a cohort in ST-elevation myocardial infarction (n=88,188). Primary percutaneous coronary intervention vs. UK populace was evaluated on Crude five-year relative survival. Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, crude five-year relative survival was 87.1%, indicating excellent long-term cardiovascular survival.
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