Of the Cardiac-specific Deaths, Deaths from Heart Attack and Sudden Heart Rhythm Disturbances declined steeply, no decline in deaths from Heart Failure in a 20,000 PCI patients Study @ Mayo Clinic
Reporter: Aviva Lev-Ari, PhD, RN
- Original Article
Trends in Cause of Death after Percutaneous Coronary Intervention
CIRCULATIONAHA.113.006518
Published online before print February 10, 2014,doi: 10.1161/CIRCULATIONAHA.113.006518
- Daniel B. Spoon1;
- Peter J. Psaltis1;
- Mandeep Singh1;
- David R. Holmes Jr.1;
- Bernard J. Gersh1;
- Charanjit S. Rihal1;
- Ryan J. Lennon1;
- Issam D. Moussa2;
- Robert D. Simari1;
- Rajiv Gulati1*
+Author Affiliations
- ↵* Mayo Clinic, 200 First Street SW, Rochester, MN 55905 gulati.rajiv@mayo.edu
Abstract
Background—The impact of changing demographics upon causes of long-term death after percutaneous coronary intervention (PCI) remains incompletely defined.
Methods and Results—We evaluated trends in cause-specific long-term mortality after index PCI performed at a single center from 1991-2008. Deaths were ascertained by scheduled prospective surveillance. Cause was determined via telephone interviews, medical records, autopsy reports and death certificates. Competing-risks analysis of cause-specific mortality was performed using three time-periods of PCI (1991-1996, 1997-2002, 2003-2008). Final follow-up was 12/31/2012. A total of 19,077 patients survived index PCI-hospitalization, of whom 6,988 subsequently died (37%, 4.48/100 person-years). Cause was determined in 6,857 (98.1%). Across three time-periods, there was a 33% decline in cardiac deaths at 5 years after PCI (incidence 9.8%, 7.4%, 6.6%) but a 57% increase in non-cardiac deaths (7.1%, 8.5%, 11.2%). Only 36.8% of deaths in the recent era were cardiac. Similar trends were observed regardless of age, extent of coronary disease or PCI indication. After adjustment for baseline variables there was a 50% temporal decline in cardiac mortality but no change in non-cardiac mortality. The decline in cardiac mortality was driven by fewer deaths from myocardial infarction/sudden death (p<0.001) but not heart failure (p=0.85). The increase in non-cardiac mortality was due primarily to cancer and chronic diseases (p<0.001).
Conclusions—This study found a marked temporal switch from predominantly cardiac to predominantly non-cardiac cardiac causes of death after PCI over two decades. The decline in cardiac mortality was independent of changes in baseline clinical characteristics. These findings have implications for patient care and clinical trial design.
Key Words:
- cardiovascular disease
- cardiac disease
- cardiac catheterization
- mortality
- percutaneous coronary intervention
- Received September 25, 2013.
- Revision received November 29, 2013.
- Accepted December 23, 2013.
SOURCE
Traci Klein (@traciklein) published a blog post · February 6th, 2014
Surprising Trends in Cause of Long-Term Death for Heart Patients
ROCHESTER, Minn. — Feb. 6, 2014 — More people who have known coronary heart disease die from other causes — such as cancer, and lung and neurological diseases — than heart disease, compared with 20 years ago, according to a Mayo Clinic study published online Feb. 10 in Circulation, an American Heart Association journal.
VIEW VIDEO – Dr. Rajiv Gulati, MD, PhD
http://www.youtube.com/watch?v=f2-4t_sAN9A
The researchers evaluated the trends in cause-specific, long-term mortality from 1991 to 2008 in patients at Mayo Clinic in Rochester who underwent percutaneous coronary intervention (PCI), a procedure used to open clogged heart arteries. They broke the study population into three eras: 1991 to 1996, 1997 to 2002, and 2003 to 2008. Cardiac deaths predominated in the first era and were about equal with non-cardiac deaths in the middle era. In the final era — the modern-era (2003 to 2008) — non-cardiac deaths dominated.
Approximately 20,000 PCI patients were studied. Of those, nearly 7,000 patients died within the study time frame. Among that group, only 37 percent of deaths in the modern-era (2003-2008) were cardiac-related.
“We found that patients with established heart disease undergoing angioplasty and stenting in the modern era have about a 1 in 3 chance of dying from their heart disease, and a 2 in 3 chance of dying from non-cardiac diseases in the long term,” says Rajiv Gulati, M.D., Ph.D., senior author and Mayo Clinic interventional cardiologist.
The results surprised the authors, Dr. Gulati says. First, patients undergoing angioplasty in the modern era have gotten older, with more complex coronary disease and more risk factors compared with years ago. So, the authors were expecting their cardiac death rates to have increased. “In addition, in randomized clinical trials of PCI, deaths from cardiac disease still predominate,” he says. The authors believe the sharp decline in long-term cardiac deaths in these patients may result from improved cardiac therapies. For example, more patients today with established heart disease take medications to lower cholesterol, prevent heart failure, and decrease blood pressure, and technologies used in catheterization laboratories — where PCI is performed — have improved, Dr. Gulati says.
Of the cardiac-specific deaths, deaths from heart attack and sudden heart rhythm disturbancesdeclined steeply, but there was no decline in deaths from heart failure.
“These results show that we have an opportunity to focus on the non-cardiac diseases in these patients — to treat the patient holistically,” Dr. Gulati says. “But it also gives us the opportunity to identify and target those patients who are at risk of dying from heart disease.”
About Mayo Clinic
Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit150years.mayoclinic.org, http://www.mayoclinic.org/ and newsnetwork.mayoclinic.org.
MEDIA CONTACT: Traci Klein, Mayo Clinic Public Affairs, 507-284-5005,newsbureau@mayo.edu
SOURCE
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