Long-term mortality and factors of poor outcomes in patients undergoing percutanenous coronary intervention

Abstract

Data concerning long-term mortality after percutaneous coronary intervention (PCI) and factors of poor outcomes are scarce. To describe short-term, intermediate-term, and long-term mortality and their correlates after PCI. In this prospective cohort study, we included and followed-up consecutive patients admitted for PCI from 2008 to 2011. Independent adjudicators reviewed the ischemic outcomes and causes of death until January 2019. A survival analysis was performed to compare the occurrence of cardiovascular and non-cardiovascular death at 30 days, one year and up to 8 years. Of the 3524, patients treated with PCI from 2008 to 2011, 2720 (77.2%) were men and 804 (22.8%) were women with a mean age of 65.8 years old. The median follow-up was 7.0 years (IQ1: 5.4; IQ3: 7.2) and complete for 97.6% of the patients. One third of the patients died (30.3%; n = 1070) in a median time of 2.5 years after PCI, with a rate of 5.3 deaths per 100 patient-years. Overall, mortality was mostly related to cardiovascular causes than non-cardiovascular causes (17.7% versus 12.6%, log-rank < 0.001) ( Fig. 1 ). Cardiovascular death was more frequent within 30 days (4.7% vs. 0.3%, P < 0.0001) and the first year after PCI (3.1% vs. 2.2 P = 0.01), but then become similar to non-cardiovascular death one year (9.9% vs. 10.2%, P = 0.67). Cancer was the major cause of non-cardiovascular death (5.6%; 1 per 100 patient-years). Diabetes (adjHR = 1.48 95% [1.29–1.71], p < 0.001), active smoking (adjHR = 1.37, 95% [1.16–1.62]) and chronic kidney disease (adjHR = 1.97, 95% [2.55–3.45], P < 0.001) were the strongest risk factors for all-cause death. Cardiovascular death was more frequent than non-cardiovascular death in patients treated with PCI in the short and intermediate-term but not beyond one year. Cancer accounted for one fifth of the overall mortality.