Abstract 4557: Mode of Death After Contemporary Percutaneous Coronary Intervention: A Report From the EVENT Multicenter Registry
BACKGROUND When selecting clinical trial endpoints, some investigators prefer to use cardiovascular death (CVD) while others believe that all-cause mortality is more relevant. The frequencies of CVD and non-CVD in unselected patients undergoing PCI are not well described.
METHODS AND RESULTS We utilized EVENT, a prospective registry of contemporary PCI at ~50 U.S. centers, to study mode of death (MOD) during the first year after PCI. Vital status was determined through contact of family members and query of the social security death index; MOD was independently adjudicated. Between 2004 – 06, EVENT enrolled 7587 patients of whom 227 (3%) died within the first year after PCI. As illustrated in the Figure⇓, 30% of deaths were cardiac, 4% were related to intracranial events, and 6% of patients had unexplained sudden death. Whereas MOD among patients with higher LV systolic function mirrored those of the full study cohort, patients with LVEF <35% had higher rates of cardiac and unknown MOD (p=0.021; Figures A–B⇓). No difference in the MOD distribution was seen for subgroups of patients with acute coronary syndromes, or with known diabetes.
CONCLUSION Among unselected patients undergoing PCI for a wide variety of clinical indications, CVD is the most common MOD during the first year after PCI. However, CVD only accounts for a minority of all deaths (~40%), and this proportion is even lower (<25%) among individuals with preserved LV function. In addition, a large proportion of patients have an indeterminate MOD; CVD as a clinical endpoint therefore is limited by ascertainment difficulties, and all-cause mortality is limited by having a majority of deaths without clear cardiovascular etiologies.