Death (After Percutaneous Coronary Intervention) Is No Longer What It Used to Be
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Percutaneous coronary intervention (PCI) has revolutionized the management of coronary artery disease.1 Its main goals are to improve the quantity and sometimes the quality of life by reducing mortality and nonfatal outcomes and by improving symptoms. Although these goals were clearly achieved when PCI was applied to the treatment of acute coronary syndromes,2,3 there is still uncertainty about the prognostic benefits of PCI in patients with stable coronary artery disease: Whereas PCI clearly improves angina symptoms, its benefits on clinical outcomes remain debated and may occur only if patients are at sufficient risk (because of extensive myocardial ischemia or because the amount of jeopardized myocardium is large enough).4–6
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In this issue, Spoon et al7 report changes in long-term mortality after PCI over nearly 20 years. This study examined 19 077 patients who underwent PCI at the Mayo Clinic in Rochester, MN, and were discharged alive. It spans 3 distinct 6-year periods: the plain old balloon angioplasty era in the early 1990s, the bare metal stent era in the late 1990s, and the drug-eluting stent era in the 2000s. The study records survivals up to 5 years after the procedure, with a detailed description of the patients’ characteristics and indications for PCI, as well as careful analysis and categorization of the causes of death.
In this study, a change in patient characteristics over time was found: PCI was performed in increasingly older patients, with an increasing prevalence of noncardiac comorbidities. In parallel, there was a clear increase in the use of evidence-based therapies for secondary prevention. In-hospital mortality decreased for patients with stable angina but not for patients with acute coronary syndrome. Interestingly, the long-term postdischarge mortality appeared consistently slightly higher in the …