Cumulative Incidence Of All-cause Death Research Articles

Comparison of 3-year clinical outcomes after transradial versus transfemoral percutaneous coronary intervention

Transradial approach is an established procedure in percutaneous coronary intervention (PCI). However, long term clinical outcomes of transradial PCI compared to transfemoral PCI have not been fully elucidated. Among 13087 patients undergoing first PCI in the CREDO-Kyoto registry Cohort-2 from January 2005 to December 2007, we identified 2736 patients with transradial approach and 4092 patients with transfemoral approach, excluding patients with acute myocardial infarction, patients on dialysis and patients treated with transbrachial approach. Using propensity score methodology, 2701 patients with transfemoral approach were randomly matched to 2701 patients with transradial approach based on clinical, angiographic, and procedural characteristics. The rates for procedural success of PCI were high in both transradial and transfemoral PCI (99 vs. 98%, P=0.57). At 30days, there was no significant difference in the incidence of all-cause death between the 2 groups (radial group 0.2% vs. femoral group 0.2%, P=0.73). Incidence of bleeding event tended to be lower in the radial group than in the femoral group (1.0 vs. 1.6%, P=0.09), and incidence of puncture site bleeding was significantly lower in the radial group than in the femoral group (0.2 vs. 0.6%, P=0.005). Through 3-year follow up, cumulative incidence of all-cause death was not significantly different between the 2 groups (5.6 vs. 6.7%, hazard ratio 0.90 (95% confidence interval 0.71-1.13), P=0.35]. In conclusion, transradial PCI reduced 30-day puncture site bleeding event compared to transfemoral PCI, with similar PCI success rates. In contrast, 3-year mortality rate was comparable between transradial and transfemoral PCI.

Long-Term Clinical Results Following Stenting of the Left Main Stem: Insights From RESEARCH (Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital) and T-SEARCH (Taxus-Stent Evaluated at Rotterdam Cardiology Hospital) Registries

We investigated the long-term clinical outcomes and independent predictors of major cardiac events in unprotected left main coronary artery disease (ULMCA) patients treated by percutaneous coronary intervention with drug-eluting stent (DES). There is limited information on long-term (>3 years) outcomes after DES implantation for ULMCA. Furthermore, bifurcation angle and SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score are emerging as parameters for patient risk stratification, and their prognostic implications have still to be elucidated. One hundred forty-eight patients with ULMCA treated with DES were analyzed and compared with a historical cohort of 79 patients who received bare-metal stents for the treatment of ULMCA. Patient-oriented composite end point was defined as the occurrence of all-cause death, any myocardial infarction, or any revascularization. The 4-year cumulative incidence of all-cause death, any myocardial infarction, any revascularization, and patient-oriented composite were 35.6%, 3.8%, 25.2%, and 54.4%, respectively. These end points had relatively increased from 1 year to 4 years by Delta70%, Delta5%, Delta50%, and Delta68%, respectively. When compared with a historical cohort who received bare-metal stents for ULMCA treatment, landmark analysis performed after the first 2 years of follow-up demonstrated that the DES cohort had significantly higher patient-oriented composite end point over the last 2 years of follow-up (26% vs. 8%, p = 0.02). EuroSCORE (European System for Cardiac Operative Risk Evaluation), cardiogenic shock, and SYNTAX score were identified as independent predictors for the 4-year patient-oriented composite, whereas bifurcation angle was not. Late increase in patient-oriented composite end points after DES implantation for ULMCA warrants careful and long-term follow-up. SYNTAX score and EuroSCORE appear to have a significant prognostic value in long-term patient risk.

Do Longer Delays for Coronary Artery Bypass Surgery Contribute to Preoperative Mortality in Less Urgent Patients?

Priority wait lists are common for managing access to cardiac surgery in publicly funded health systems. We evaluated whether longer delays contribute to the probability of death before surgery among patients prioritized into the less urgent category. We studied records of 9233 patients registered for isolated coronary artery bypass graft (CABG) in British Columbia, Canada. The primary outcome was death before surgery. We estimated the probability that a patient, who could be removed from the list as a result of surgery, death, or other competing events, dies on or before a certain wait-list week. Despite similar death rates in semiurgent and nonurgent groups, 0.63 (95% confidence interval, 0.46-0.80) versus 0.58 (0.36-0.80) per 1000 patient-weeks, nonurgent patients were remaining on the list longer, which contributed to higher cumulative incidence of all-cause death than in semiurgent group (adjusted odds ratio = 1.66; 1.03-2.68). By 52 weeks on the wait list, 0.9% (0.6-1.1) and 1.3% (0.8-1.8) of patients died in semiurgent and nonurgent groups, respectively (P < 0.01). Similar proportions of deaths related to cardiovascular disease estimated over wait-list time in both groups (P = 0.40) were the result of shorter delays in the semiurgent group despite a higher rate of death resulting from cardiovascular disease (0.50 [0.36-0.65] vs. 0.34 [0.17-0.51] per 1000 patient-weeks). Queuing according to urgency of treatment contributed to a higher proportion of CABG candidates dying before surgery from all causes in the nonurgent compared with the semiurgent group despite similar weekly death rates observed in both groups. However, similar probabilities of death resulting from cardiovascular disease observed in both groups over wait-list time were the result of shorter delays in the semiurgent group despite a higher rate of cardiovascular death.