Comparison of clinical outcomes according to presentation of angina pectoris versus acute myocardial infarction in patients who underwent a percutaneous coronary intervention with a drug-eluting stent.

Abstract

Although randomized clinical trials are valuable tools to compare treatment effects, the results of randomized clinical trials cannot usually be extrapolated to the real-world setting because of selected patient subsets. To categorize the risk of future cardiovascular events in drug-eluting stent (DES)-treated patients, we analyzed demographic, clinical, and procedural data in all-comers who underwent a percutaneous coronary intervention (PCI). Patients who underwent PCI using DES from January 2004 were prospectively enrolled in the Catholic University of Korea-PCI registry and were followed up for a median of 2 years. We analyzed the risk of clinical outcomes in the all-patient cohort and in subsets of patients with angina and acute myocardial infarction (AMI). The patients were categorized into two groups: those with angina (angina group, n=6183, 67.7%) and those with AMI (AMI group, n=2944, 32.3%). The AMI group had greater occurrence of major adverse cardiac events (MACE) during long-term follow-up than the angina group (23.8 vs. 20.1%, P<0.001). However, in the landmark analysis of data beyond 1 year, there was no significant difference in the occurrence of MACE between the two groups (P=0.44). In multivariable modeling, age, renal function, left ventricular ejection fraction, and multivessel disease were associated significantly with increasing MACE in the study population, angina or AMI groups. We found that higher MACE in patients with AMI during long-term follow-up after PCI was mainly because of higher mortality in the first year. Some demographic, clinical, and angiographic factors still significantly influence the long-term occurrence of MACE in the era of DES.