Temporal trends in clinical outcomes after percutaneous coronary intervention: a systematic review of 66,327 patients from 25 all-comers trials

Asano, Taku; Ono, Masafumi; Dai, Zhehao; Saito, Akira; Kanie, Takayoshi; Takaoka, Yoshimitsu; Mizuno, Atsushi; Yoneoka, Daisuke; Komiyama, Nobuyuki

doi:10.4244/eij-d-21-00192

Cited by 12 publications

(9 citation statements)

References 41 publications

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“…(7,14) A recent systematic review examining trends in PCI outcomes from 25 all-comers trials excluded STEMI patients. (15) The present analysis not only finds no improvement in mortality over time in the anterior STEMI population treated with timely PCI but suggests a potential worsening. Given that these findings are demonstrated with two different risk-adjustment models, it is not likely that this is attributable to applying primary PCI to higher risk patients over time.…”

Section: Discussioncontrasting

confidence: 60%

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The Persistent Mortality and Heart Failure Burden of Anterior ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention

Martin

2022

Preprint

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Background There is limited data on temporal trends in clinical outcomes after ST–segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) particularly beyond one year and in real world populations that include patients often excluded from randomized trials. Objectives We sought to compare the temporal trends in the incidence of death and re–hospitalization for congestive heart failure (CHF) following anterior STEMI in a Medicare cohort of beneficiaries treated with primary PCI in 2005 (n = 1,479) with those treated in 2016 through quarter (Q) 2 of 2017 (n = 22,432). Methods Outcomes were examined using both descriptive and regression analysis to control for differences in patient clinical characteristics over time. Results The 1–year mortality rate trended higher in the late cohort (10.3 vs 8.9%, p=0.068). The 2–year mortality rate was significantly higher in the late cohort (14.5 vs 11.4%, p <0.01). The one–year re–hospitalization for CHF was lower in the late cohort (10.6 versus 16.7%, p <0.01), but the 2–year rate was unchanged (19.3 vs 20.7%, p=0.55). After adjustment for covariates with two models there were highly statistically significant increases in mortality at 1–year (2.3 – 4.1%) and 2–years (4.2 – 6.5%) in the late cohort. The unadjusted trends in re–hospitalization for CHF persisted after adjustment for covariates. Conclusions Despite prior improvements in STEMI outcomes in the reperfusion era related to the broad adoption of timely PCI, there is a persistent high mortality and CHF burden in patients with anterior STEMI. New strategies that address reperfusion injury and enhance myocardial salvage are needed.

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Section: Discussioncontrasting

confidence: 60%

“…(7, 14) A recent systematic review examining trends in PCI outcomes from 25 all-comers trials excluded STEMI patients. (15)…”

Section: Discussionmentioning

confidence: 99%

The Persistent Mortality and Heart Failure Burden of Anterior ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention

Martin

2022

Preprint

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“…This is particularly the case for data on all-comers including patients not enrolled in randomised trials 7 14. A recent systematic review examining trends in PCI outcomes from 25 all-comers trials excluded STEMI patients 15…”

Section: Discussionmentioning

confidence: 99%

Persistent mortality and heart failure burden of anterior ST-segment elevation myocardial infarction following primary percutaneous coronary intervention: real-world evidence from the US Medicare Data Set

Martin

2023

BMJ Open

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ObjectivesWe sought to compare the temporal trends in the incidence of death and rehospitalisation for congestive heart failure (CHF) following anterior ST-elevation myocardial infarction (STEMI) in a Medicare cohort of beneficiaries treated with primary percutaneous coronary intervention (PCI) in 2005 (n=1479) with those treated in 2016 through quarter (Q) 2 of 2017 (n=22 432).DesignThis retrospective analysis examined outcomes using both descriptive and regression analysis to control for differences in patient clinical characteristics over time.Primary outcome measuresThe primary outcomes are 1 year and 2 year rates of mortality and re-hospitalisation for CHF.ResultsThe 1 year mortality rate was numerically higher in the 2016 cohort at 10.3% (95% CI 9.9 to 10.7) versus 8.9% (CI 7.4 to 10.3; p=0.068). The 2 year mortality rate was significantly higher in the 2016 cohort at 14.5% (CI 13.9 to 15.1) versus 11.4% (CI 9.2 to 13.6; p<0.01). The 1 year rehospitalisation for CHF was lower in the 2016 cohort at 10.6% (CI 10.0 to 11.2) versus 16.7% (CI 14.0 to 19.4; p<0.001), but the 2 year rate was not significantly different at 19.3% (CI 17.7 to 20.9) versus 20.7% (CI 16.4 to 24.9; p=0.55). After adjustment for covariates with two models, the 1 year mortality increased by 2.3% (CI 0.8 to 3.7; p<0.01) and 4.1% (CI 2.6 to 5.6; p<0.001) in the 2016 cohort. The 2 year adjusted mortality also increased by 4.2% (CI 2.0 to 6.4; p<0.001) and 6.5% (CI 4.2 to 8.7; p<0.001) in the 2016 cohort. The risk adjusted trends for rehospitalisation for CHF were similar to the unadjusted findings.ConclusionsDespite prior improvements in STEMI outcomes in the reperfusion era related to the broad adoption of timely PCI, there is a persistent high mortality and CHF burden in Medicare beneficiaries with anterior STEMI. New strategies that address reperfusion injury and enhance myocardial salvage are needed.

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“…In the subgroup analysis of those with SBP < 100 mmHg, it was found that patients with ACEI use had a higher incidence of 30-day mortality (13.1% vs. 12.0%), but without statistical significance. However, after more than 20 years of medical development, the mortality rate of AMI has decreased significantly ( 5 , 22 ). The main intervention of reperfusion has also changed from fibrinolytic therapy to PCI ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, after more than 20 years of medical development, the mortality rate of AMI has decreased significantly ( 5 , 22 ). The main intervention of reperfusion has also changed from fibrinolytic therapy to PCI ( 22 ). Therefore, there is a large clinical heterogeneity between these studies and our study.…”

Section: Discussionmentioning

confidence: 99%

Early ACEI/ARB use and in-hospital outcomes of acute myocardial infarction patients with systolic blood pressure <100 mmHg and undergoing percutaneous coronary intervention: Findings from the CCC-ACS project

Zhao

Zhou

et al. 2022

Front. Cardiovasc. Med.

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BackgroundFew studies have evaluated whether acute myocardial infarction (AMI) patients with relatively low blood pressure benefit from early ACEI/ARB use in the era of percutaneous coronary intervention (PCI).ObjectivesThis study evaluated the associations of ACEI/ARB use within 24 h of admission with in-hospital outcomes among AMI patients with SBP < 100 mmHg and undergoing PCI.MethodsThis study was based on the Improving Care for Cardiovascular Disease in China-ACS project, a collaborative registry and quality improvement project of the American Heart Association and the Chinese Society of Cardiology. Between November 2014 and December 2019, a total of 94,623 patients with AMI were enrolled. Of them, 4,478 AMI patients with SBP < 100 mmHg and undergoing PCI but without clinically diagnosed cardiogenic shock at admission were included. Multivariable logistic regression and propensity score-matching analysis were used to evaluate the association between early ACEI/ARB use and in-hospital major adverse cardiac events (MACEs), a combination of all-cause death, cardiogenic shock, and cardiac arrest.ResultsOf AMI patients, 24.41% (n = 1,093) were prescribed ACEIs/ARBs within 24 h of admission. Patients with early ACEI/ARB use had a significantly lower rate of MACEs than those without ACEI/ARB use (1.67% vs. 3.66%, p = 0.001). In the logistic regression analysis, early ACEI/ARB use was associated with a 45% lower risk of MACEs (odds ratio: 0.55, 95% CI: 0.33–0.93; p = 0.027). Further propensity score-matching analysis still showed that patients with early ACEI/ARB use had a lower rate of MACEs (1.96% vs. 3.93%, p = 0.009).ConclusionThis study found that among AMI patients with an admission SBP < 100 mmHg undergoing PCI, early ACEI/ARB use was associated with better in-hospital outcomes. Additional studies of the early use of ACEIs/ARBs in AMI patients with relatively low blood pressure are warranted.

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Temporal trends in clinical outcomes after percutaneous coronary intervention: a systematic review of 66,327 patients from 25 all-comers trials

Cited by 12 publications

References 41 publications

The Persistent Mortality and Heart Failure Burden of Anterior ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention

The Persistent Mortality and Heart Failure Burden of Anterior ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention

Persistent mortality and heart failure burden of anterior ST-segment elevation myocardial infarction following primary percutaneous coronary intervention: real-world evidence from the US Medicare Data Set

Early ACEI/ARB use and in-hospital outcomes of acute myocardial infarction patients with systolic blood pressure <100 mmHg and undergoing percutaneous coronary intervention: Findings from the CCC-ACS project

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