Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

Pedersen, Frants; Butrymovich, Vitalij; Kelbæk, Henning; Wachtell, Kristian; Helqvist, Steffen; Kastrup, Jens; Holmvang, Lene; Clemmensen, Peter; Engstrøm, Thomas; Grande, Peer; Saunamäki, Kari; Jørgensen, Erik

doi:10.1016/j.jacc.2014.08.037

Cited by 323 publications

(259 citation statements)

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“…About the causes of deaths after STEMI, Pedersen et al 4 recently reported that patients who survived the first month after STEMI treated with primary PCI had excellent prognosis, with <1.5% annual risk of cardiac death, and noncardiac causes were responsible for the majority of later deaths in their cohort study. Consistent with this report, the long-term risk for cardiac death in the current study was relatively low (1.1%…”

Section: Discussionmentioning

confidence: 99%

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

Yamashita

Shiomi

Morimoto

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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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...

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Section: Discussionmentioning

confidence: 99%

“…4 It is not known whether the observed predominance of noncardiac death is true in different geographic area and age groups.…”

mentioning

confidence: 99%

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

Yamashita

Shiomi

Morimoto

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…In an era of intense pharmacovigilance, our study seeks to clarify concerns raised by DAPT, especially when considering that cancer has overtaken cardiac events as the primary mortality cause after percutaneous coronary intervention (30,31). Additionally, the use of random effects model in our statistical analysis permits inferences of the results to the wider population.…”

Section: Discussionmentioning

confidence: 99%

Cancer Event Rate and Mortality with Thienopyridines: A Systematic Review and Meta-Analysis

et al. 2016

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Introduction: Thienopyridines are a class of antiplatelet drugs widely used in cardiovascular disease prevention and treatment. There is recent concern regarding the safety of thienopyridines because of possible malignancy risk. Therefore, we performed a systematic review and meta-analysis to evaluate the association between thienopyridine exposure and malignancy. Methods:We searched MEDLINE and EMBASE in March 2016 for studies which evaluated incident cancer and cancer mortality with and without exposure to thienopyridines. Relevant studies were identified, data were extracted and analysed with random effects meta-analysis.Results: A total of 9 studies (6 randomised controlled trials and 3 cohort studies) with 311,595 participants were included. The cancer event rate during the study period with clopidogrel and prasugrel was 1.56%. When compared to standard aspirin or placebo, thienopyridines are not significantly associated with cancer mortality and event rate OR 1.12 [95% CI 0.80-1.56, n=3] and OR 0.92 [95% CI 0.52-1. 64, n=2] respectively. Further analyses examining clopidogrel only showed no significant association with cancer event rate or malignancy related death. When comparing prasugrel to clopidogrel no significant association was noted for cancer event rate OR 1.10 [95% CI 0.89-1.37, n=2]. Subanalyses according to cancer location showed that thienopyridines are not significantly associated with malignancy mortality and/or incidence. Conclusions:Our results suggest that there is currently insufficient evidence to suggest that thienopyridine exposure is associated with an increased risk of cancer event rate or mortality. 3 Key points:• Cancer-related mortality is not linked to thienopyridines with contemporary data• Standardisation of cancer-end points in trials will reduce adjudication bias• Cohort studies can be used to supplement trial findings due to longer follow-up 4

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“…Causes of death: We used and modified a previously published death classification system of STEMI to analyze the direct causes of death in our patients. 8) In brief, the cause of death was classified as either a cardiovascular or a non-cardiovascular cause. Cardiovascular death was further classified as cardiac, vascular, and arrhythmic death.…”

Section: Methodsmentioning

confidence: 99%

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

et al. 2016

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SummaryIt is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10-year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death. (Int Heart J 2016; 57: 541-546) Key words: Acute myocardial infarction, Coronary angioplasty, Mortality A cute myocardial infarction is an important public health issue in Taiwan because it carries a high fatality rate and its incidence is still increasing. 1) In acute ST-segment elevation myocardial infarction (STEMI), timely primary percutaneous coronary intervention (PCI) and the use of evidence-based medications significantly decrease mortality, and are strongly recommended in local 2) and international guidelines.3,4) In Taiwan, more than 95% of STEMI patients received primary PCI as the initial reperfusion therapy, and the door-to-balloon (D2B) time has improved. 5,6) A previous observational study demonstrated that early primary PCI could decrease the incidence of cardiogenic shock, which is the major cause of death in STEMI.7) It is unknown whether there has been any temporal change in the causes of death during hospitalization for STEMI with the advent of aggressive reperfusion in recent years. Information on the specific causes of death can reveal the weak points of current treatment and enable the implementation of new strategies to improve the quality of care for STEMI patients treated with primary PCI. The major aims of the present study were to describe the 10-year secular trends in the clinical characteristics and management of STEMI patients treated with primary PCI, and to specifically analyze the causes of death in these patients in a tertiary referral c...

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Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

Abstract: Patients who survive the first month after an STEMI treated with primary PCI have an excellent prognosis, with a <1.5% annual risk of successive cardiac death. Noncardiac causes are responsible for the majority of later deaths in these patients.

Cited by 323 publications

References 33 publications

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

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

Cancer Event Rate and Mortality with Thienopyridines: A Systematic Review and Meta-Analysis

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

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