Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes?

Sinjini Biswas, Nick Andrianopoulos, Stavroula Papapostolou, Samer Noaman, Stephen J. Duffy, Jeffrey Lefkovits, Angela Brennan, Antony Walton, James A. Shaw, Andrew Ajani, David J. Clark, Melanie Freeman, Chin Hiew, Ernesto Oqueli, Christopher M. Reid, Dion Stub, William Chan

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3 Citations (Scopus)

Abstract

Aims The prognosis of patients undergoing percutaneous coronary intervention (PCI) for different subtypes of acute coronary syndromes (ACS) remains unclear. We compared short- and long-term mortality in patients undergoing PCI for unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). Methods and results This was a retrospective cohort study of 13 184 patients (5966 STEMI, 5307 NSTEMI, and 1911 UA) undergoing PCI between 1 January 2005 and 30 November 2013 in a multi-centre registry. Clinical and procedural characteristics, as well as outcomes, were compared by ACS subtype. Long-term all-cause mortality data were obtained via linkage to the National Death Index (NDI). Patients with STEMI compared with NSTEMI and UA were younger (62.9 ± 12.8 vs. 64.7 ± 12.5 vs. 65.5 ± 11.8 years; P < 0.01), had fewer comorbidities including diabetes, heart failure, and previous myocardial infarction (all P < 0.01). Procedural success was similar across all groups (P = 0.54). In-hospital, 30-day and 1-year all-cause mortality increased significantly from UA to NSTEMI to STEMI patients (1-year mortality 2.5% vs. 4.5% vs. 8.7%; P < 0.01). Kaplan-Meier survival estimates showed increased early mortality in the STEMI group (log-rank P < 0.01). However, after approximately 8.2 years, survival was similar across all groups. In a proportional-odds model using flexible parametric survival modelling, ACS subtype was not an independent predictor of NDI-linked mortality [UA: odds ratio (OR) 0.85, 95% CI 0.71-1.02; STEMI: OR 1.01, 95% confidence interval (CI) 0.88-1.16; NSTEMI as reference category]. Conclusion Despite disparate baseline characteristics and differences in short-term mortality, long-term mortality was similar across the spectrum of ACS treated by PCI and contemporary medical therapy.

Original languageEnglish
Pages (from-to)318-327
Number of pages10
JournalEuropean Heart Journal - Quality of Care & Clinical Outcomes
Volume4
Issue number4
DOIs
Publication statusPublished - Oct 2018

Keywords

  • Acute coronary syndrome
  • Outcomes
  • Percutaneous coronary intervention

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