Trends in Cause-Specific Mortality after Percutaneous Coronary Intervention (PCI): Observations from the Alberta Provincial Project for Outcome assessment in Coronary Heart disease (APPROACH) Registry

  • Author / Creator
    Barake, Walid
  • Objectives: This study evaluated trends in 30-day, 1-, and 2-year cause-specific mortality using a large, contemporary cohort undergoing percutaneous coronary intervention (PCI).
    Background: Prior work has shown that patients undergoing percutaneous coronary intervention (PCI) are older with higher comorbidities in the past decade, yet population-based data examining the impact of these demographic shifts on cause-specific mortality after PCI remain scant.
    Methods: We used the APPROACH registry (Alberta Provincial Project for Outcome assessment in Coronary Heart disease) which captures demographic, clinical, and angiographic data on all the patients undergoing coronary angiogram in Alberta, Canada to identify consecutive patients > 20 years undergoing PCI from the year 2005 to 2013. The cause of death was provided by the Bureau of Vital Statistics and was classified as cardiac or non-cardiac.
    Results: Of the 35,602 patients who underwent PCI, 5284 (14.8%) died over a median follow-up of 66 months. In more recent years, patients were older, had more cardiovascular comorbidities, and more PCIs were done for acute coronary syndrome. The 30-day, 1-and 2-year adjusted total mortality after PCI increased significantly over the 9 years (p<0.001). Overall, the most common cause of death was cardiac but non-cardiac deaths increased 28% as time from PCI increased (proportion of non-cardiac deaths: 30-day=11.5%, 1-year=31.5%, 2-year=39.6%; p for trend=<0.001). By 3 years post-PCI, the most common cause of death was non-cardiac for all indications other than ST-elevation myocardial infarction (STEMI); where cardiac remained the predominant cause of death to 6 years.
    Conclusion: In this real-world registry, as clinical profiles of patients undergoing PCI worsen, total mortality is increasing. The primary contributor to short-term mortality is cardiac but by 3 years post-PCI non-cardiac mortality predominates except in STEMI patients.

  • Subjects / Keywords
  • Graduation date
    Fall 2018
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
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