| Major adverse noncardiac events after PCI as predictors of long-term mortality. | |
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MedLine Citation:
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PMID: 18705635 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Studies of percutaneous coronary intervention (PCI) routinely report major adverse cardiovascular events (MACE), but not major adverse noncardiac events (MANE) after PCI. MANE, such as post-PCI bleeding and contrast nephropathy, adversely influence survival, but are not recognized as a standard composite of complications. We assessed the feasibility and prognostic utility of deriving a composite of MANE. METHODS: In 985 consecutive patients who underwent PCI, we estimated the incidence and prognostic impact of in-hospital MACE (myocardial infarction [MI] target vessel revascularization, or stroke) and MANE (defined as thrombolysis in myocardial infarction [TIMI], bleeding [major or minor], or contrast nephropathy) and their impact on long-term survival. RESULTS: The incidence of MANE was >6-fold greater than MACE (9.5% vs 1.5%). Independent correlates of MANE included age, female gender, peripheral vascular disease, lower left ventricular ejection fraction, and use of an intraaortic balloon pump (IABP) during PCI. Of 973 patients who survived the index hospitalization, death occurred in 169(17%) at a median follow-up of 4.0 years. MANE (but not MACE) showed a significant relation with survival; 34 of 85 patients with MANE compared to 135 of 888 patients without MANE died during follow-up (40% vs 15%, log-rank P < 0.0001). After adjustment for several baseline clinical features, the occurrence of MANE was independently associated with a significant increase in long-term mortality (adjusted hazards ratio [HR]= 1.72, CI = 1.05-2.83) and myocardial infarction (adjusted HR = 3.43, CI = 1.55-7.58). CONCLUSIONS: After PCI, MANE are common and carry grave long-term prognostic significance. Our findings emphasize the need to monitor and report MANE, in addition to MACE, in PCI-related trials. |
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Authors:
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Kishore Harjai; Chetan Shenoy; Amol Raizada; Manivel Eswaran; Subasit Acharji; Sudhakar Sattur; Pamela Orshaw; Srinivas Devarakonda |
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Publication Detail:
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Type: Journal Article Date: 2008-08-13 |
Journal Detail:
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Title: Journal of interventional cardiology Volume: 21 ISSN: 1540-8183 ISO Abbreviation: J Interv Cardiol Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-11-17 Completed Date: 2009-03-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8907826 Medline TA: J Interv Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 395-402 Citation Subset: IM |
Affiliation:
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Guthrie Clinic, One Guthrie Square, Sayre, PA 18840, USA. harjai_kishore@guthrie.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Contrast Media / adverse effects Coronary Angiography / adverse effects* Female Follow-Up Studies Humans Incidence Male Middle Aged Myocardial Revascularization / adverse effects* Outcome and Process Assessment (Health Care) Pennsylvania / epidemiology Prognosis Proportional Hazards Models Treatment Outcome Vascular Diseases / mortality*, therapy* |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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