Outcomes after percutaneous coronary intervention in stable coronary artery disease: a multi-centre Australian Registry Review.

Abstract

Background: Randomised studies comparing percutaneous coronary intervention (PCI) with medical therapy for stable coronary artery disease (CAD) have found that PCI has no prognostic benefit. This underscores the need to show that PCI is a safe procedure, particularly with the introduction of more advanced techniques, newer stent types, and adjuvant medical therapy. This study reported the early and long-term mortality of PCI for stable CAD in the real world.

Method: Consecutive patients presenting with stable angina and who underwent PCI from the Melbourne Interventional Group (MIG) registry between 2005 and 2017 were analysed, with yearly comparison for trend. National Death Index (NDI) linkage was used to determine 5-year mortality rates and for Cox proportional hazards modelling.

Results: A total of 8,391 procedures were captured. Key comparators are shown in the table below:20052017p-value trendMean age, years ± SD65.1 ± 10.566.2 ± 10.70.06Age >80 years (%)5.69.10.02Diabetes (%)26.131.5<0.01Previous PCI (%)31.642.2<0.01American College of Cardiology and American Heart Association types B2 and C (%)44.764.5<0.01Chronic occlusion (%)1.76.2<0.01Drug-eluting stent use (%)48.788.1<0.01Procedural success (%)96.294.9<0.01In-hospital mortality (%)0.00.00.75

The 5-year mortality from 2012 was 12.2% compared to 9.3% from 2005 (p = 0.41). Major independent predictors of NDI-linked mortality hazards included estimated glomerular filtration rate (eGFR) <30 mL/minute/1.73 m2 (HR 3.72, p < 0.01) and left ventricular ejection fraction (LVEF) <30% (HR 2.00, p < 0.01)

Conclusion: This large, 13-year, multi-centre registry of patients with stable coronary artery disease demonstrated that, despite increasing patient and angiographic risk profiles, the in-hospital mortality was extremely low, with good long-term patient survival.