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Title: Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes?
Author: Biswas, Sinjini
Andrianopoulos, Nick
Papapostolou, Stavroula
Noaman, Samer
Duffy, Stephen J.
Lefkovits, Jeffrey
Brennan, Angela
Walton, Antony
Shaw, James A.
Ajani, Andrew
Clark, David J.
Freeman, Melanie
Hiew, Chin
Oqueli, Ernesto
Reid, Christopher M.
Stub, Dion
Chan, William
Issue Date: 2018
Publication Title: European Heart Journal - Quality of Care and Clinical Outcomes
Volume: 4
Issue: 4
Start Page: 318
End Page: 327
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.
ISSN: 0195-668X
Internal ID Number: 01146
Type: Journal Article
Appears in Collections:Research Output

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