Cardiac and Noncardiac Causes of Long-Term Mortality in ST-Segment–Elevation Acute Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention

Abstract

A cute myocardial infarction (AMI) remains one of the leading causes of mortality worldwide. 1 In recent decades, in-hospital mortality after ST-segment-elevation AMI (STEMI) has dramatically decreased to ≈5% because of the establishment of coronary care units, improvements in medical therapy, and widespread use of early reperfusion therapy by primary percutaneous coronary intervention (PCI). 2 However, the long-term risks and causes of deaths beyond the acute phase of STEMI have not been adequately evaluated yet although the majority of patients having STEMI survive to discharge from hospital in the current clinical practice.3 A study reported that noncardiac causes were responsible for the majority of late deaths in STEMI patients. 4 It is not known whether the observed predominance of noncardiac death is true in different geographic area and age groups.Therefore, we sought to evaluate short-term (within 6-month) and long-term (beyond 6-month) incidences and causes of deaths in STEMI patients who underwent primary PCI in a large-scale observational database of AMI in Japan.Background-In patients with ST-segment-elevation acute myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention, long-term risks for cardiac and noncardiac death beyond acute phase of STEMI have not been thoroughly evaluated yet. Methods and Results-We identified 3942 STEMI patients who had primary percutaneous coronary intervention within 24 hours after onset between January 2005 and December 2007 in the CREDO-Kyoto AMI registry (Coronary Revascularization Demonstrating Outcome study in Kyoto Acute Myocardial Infarction) and evaluated their short-term (within 6-month) and long-term (beyond 6-month) incidences and causes of deaths. The cumulative 5-year incidence of all-cause death in the current study population was 20.4% (cardiac death, 12.2% and noncardiac death, 9.4%, respectively). The vast majority of deaths were cardiac in origin within 6-month (cardiac death, 8.0% and noncardiac death, 0.9%), whereas noncardiac death accounted for nearly two thirds of all-cause death beyond 6-month (cardiac death, 4.6% and noncardiac death, 8.5%). In the stratified analysis according to age, the proportion of noncardiac death was similar regardless of age although the absolute mortality rate was higher with increasing age. By the multivariable Cox regression models, the independent risk factors of all-cause death were advanced age, cardiogenic shock, renal dysfunction, large infarct size, and anterior wall infarction within 6 months after STEMI, and advanced age, previous heart failure, renal dysfunction, and liver cirrhosis beyond 6 months after STEMI, respectively. Conclusions-In STEMI patients who underwent primary percutaneous coronary intervention, the long-term risk for cardiac death was relatively low compared with that for noncardiac death, which accounted for nearly two thirds of all-cause death beyond 6 months. Methods Study PopulationThe CREDO-Kyoto AMI registry (Coronary Revascularization Demonstrating Outc...

Relationship of left ventricular end‐diastolic pressure with extent of myocardial ischemia, myocardial salvage and long‐term outcome in patients with ST‐segment elevation myocardial infarction

“…First, an association between LVEDP and all‐cause mortality observed in univariable analysis was abolished after adjustment for potential confounders. Although the reasons for the latter finding remain unclear, this may reflect the increasing contribution of noncardiac mortality to overall mortality in contemporary patients with STEMI treated with primary PCI . Second, although LVEDP was independently associated with long‐term cardiac mortality, it offered limited incremental prognostic information on top of baseline characteristics regarding prediction of this outcome.…”

Association of the low e′ and high E/e′ with long-term outcomes in patients with normal ejection fraction: a hospital population-based observational cohort study

“…The subgroup analysis implies that the association of e′<7 and E/e′>14 with outcomes was directionally weak in patients over 70 years, the presence of hypertension and ischaemic heart disease, and women. The higher prevalence of non-cardiovascular events in aged people or ischaemic heart disease26 may hamper the association between diastolic dysfunction and outcomes. In addition, age dependence of e′ has been quantified recently 22 27 28.…”

“…In patients with hypertension and ischaemic heart disease, the reference group (ie, the e′≥7 group) showed the high incidence of primary endpoints. Patients with hypertension and ischaemic heart disease are strongly associated with cardiovascular events30–34; LV hypertrophy and elevated blood pressure in patients with hypertension or interventional or pharmacological therapy in patients with ischaemic heart disease26 may be related to the prognosis of those patients. Thus, an additive value of e′<7 and E/e′>14 on the risk stratification may be limited in patients in the present study.…”

Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction

“…The discovery and subsequent adoption of novel evidence-based therapies in patients suffering from acute ST-elevation myocardial infarction (STEMI) during the last decades led to a significant improvement of survival and dramatically reduced the risk of recurrent cardiovascular events [1]. However, remaining differences in the risk for future cardiovascular events stimulates the ongoing search for optimized patient-specific prognostication soon after STEMI [2]. Cardiac magnetic resonance (CMR) imaging performed during the early phase post-STEMI has been intensively investigated for this purpose.…”