Trends in Cause of Death after Percutaneous Coronary Intervention
Background—The impact of changing demographics upon causes of long-term death after percutaneous coronary intervention (PCI) remains incompletely defined.
Methods and Results—We evaluated trends in cause-specific long-term mortality after index PCI performed at a single center from 1991-2008. Deaths were ascertained by scheduled prospective surveillance. Cause was determined via telephone interviews, medical records, autopsy reports and death certificates. Competing-risks analysis of cause-specific mortality was performed using three time-periods of PCI (1991-1996, 1997-2002, 2003-2008). Final follow-up was 12/31/2012. A total of 19,077 patients survived index PCI-hospitalization, of whom 6,988 subsequently died (37%, 4.48/100 person-years). Cause was determined in 6,857 (98.1%). Across three time-periods, there was a 33% decline in cardiac deaths at 5 years after PCI (incidence 9.8%, 7.4%, 6.6%) but a 57% increase in non-cardiac deaths (7.1%, 8.5%, 11.2%). Only 36.8% of deaths in the recent era were cardiac. Similar trends were observed regardless of age, extent of coronary disease or PCI indication. After adjustment for baseline variables there was a 50% temporal decline in cardiac mortality but no change in non-cardiac mortality. The decline in cardiac mortality was driven by fewer deaths from myocardial infarction/sudden death (p<0.001) but not heart failure (p=0.85). The increase in non-cardiac mortality was due primarily to cancer and chronic diseases (p<0.001).
Conclusions—This study found a marked temporal switch from predominantly cardiac to predominantly non-cardiac cardiac causes of death after PCI over two decades. The decline in cardiac mortality was independent of changes in baseline clinical characteristics. These findings have implications for patient care and clinical trial design.
- cardiovascular disease
- cardiac disease
- cardiac catheterization
- percutaneous coronary intervention
- Received September 25, 2013.
- Revision received November 29, 2013.
- Accepted December 23, 2013.