Document Detail


Late outcomes following percutaneous coronary interventions: results from a large, observational registry.
MedLine Citation:
PMID:  20847967     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Randomized controlled trials report short- and medium- term outcomes following percutaneous coronary intervention (PCI), but their applicability to the general population is not known. Data regarding the long-term clinical outcomes of patients undergoing PCI are lacking.
OBJECTIVE: To determine the long-term outcomes of 'all-comers' undergoing PCI at a large-volume tertiary cardiac referral centre.
METHODS: A total of 12,662 consecutive patients undergoing an index procedure and entered into the University Health Network's (Toronto, Ontario) prospective registry between April 2000 and September 2007 were identified. In-hospital outcomes were assessed. Follow-up data were obtained through linkage to a provincial registry. Kaplan-Meier analysis was performed to calculate unadjusted survival rates, and Cox multiple regression analysis identified independent predictors of late mortality, major adverse cardiac events and all cardiovascular events.
RESULTS: The population included a relatively high-risk patient cohort, with 19% older than 75 years of age, 28% with diabetes, 61% with multivessel disease and 1.3% in cardiogenic shock. Urgent procedures comprised 53% of all cases. The all-cause mortality rate at seven years follow-up was 10.6%. Repeat PCI occurred in 14.2% of patients, and coronary artery bypass grafting in 4.2%. Men showed a significant unadjusted survival advantage compared with women. Procedural characteristics such as incomplete revascularization and residual stenosis, in addition to established risk factors, were predictors of poorer long-term outcomes. Cardiogenic shock was the strongest predictor of late mortality.
CONCLUSION: In the present large registry of 'all-comers' for PCI, longterm major adverse cardiac event rates were low and consistent with outcomes from randomized controlled trials. These data reflect a large cohort in real-world clinical practice, and may help clinicians further characterize and better treat high-risk patients who are undergoing PCI.
Authors:
Clare E Appleby; Karen Mackie; Vladimír Dzavík; Joan Ivanov
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  26     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:    2010 Aug-Sep
Date Detail:
Created Date:  2010-09-17     Completed Date:  2010-10-15     Revised Date:  2011-08-03    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  e218-24     Citation Subset:  IM    
Affiliation:
University Health Network, University of Toronto, Ontario.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary* / mortality
Cohort Studies
Coronary Artery Bypass / mortality
Coronary Artery Disease / diagnosis,  mortality,  surgery,  therapy*
Drug-Eluting Stents / statistics & numerical data
Female
Follow-Up Studies
Hospitals, University
Humans
Kaplan-Meier Estimate
Male
Medical Records
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Regression Analysis
Risk Factors
Stents* / statistics & numerical data
Survival Analysis
Treatment Outcome
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