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Coronary artery disease
Original article
Determinants of excess mortality following unprotected left main stem percutaneous coronary intervention
  1. O A Alabas1,
  2. R A Brogan1,2,
  3. M Hall1,
  4. S Almudarra1,
  5. M J Rutherford3,
  6. T B Dondo1,
  7. R Feltbower1,
  8. N Curzen4,
  9. M de Belder5,
  10. P Ludman6,
  11. C P Gale1,2
  12. on behalf of the National Institute for Cardiovascular Outcomes Research7
  1. 1MRC Bioinformatics Unit, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
  2. 2Department of Cardiology, York Teaching Hospital NHS Foundation Trust, York, UK
  3. 3Department of Health Sciences, University of Leicester, Leicester, UK
  4. 4Department of Cardiology, University Hospital Southampton NHS FT & Faculty of Medicine, University of Southampton, Southampton, UK
  5. 5Department of Cardiology, South Tees Hospitals NHS Foundation Trust, UK
  6. 6Department of Cardiology Queen Elizabeth Hospital, Birmingham, UK
  7. 7National Institute for Cardiovascular Outcomes Research (NICOR), University College, London, UK
  1. Correspondence to Dr Oras Alabas, MRC Bioinformatics Unit, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK; o.alabas{at}leeds.ac.uk

Abstract

Objective For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality.

Methods A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI−CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56.6 million people. Relative survival and excess mortality were estimated.

Results Over 26 105 person-years follow-up, crude 5-year relative survival was 93.8% for CSA, 73.1% for NSTEACS, 77.5% for STEMI−CS and 28.5% for STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73, 95% CI 4.06 to 11.15), and for NSTEACS and STEMI−CS was preprocedural ventilation (6.25, 5.05 to 7.75 and 6.92, 4.25 to 11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural thrombolysis in myocardial infarction (TIMI) 0 flow (2.78, 1.87 to 4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61 to 0.90).

Conclusions Long-term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI−CS, the requirement for preprocedural ventilation was the strongest determinant of excess mortality. By contrast, among STEMI+CS, in whom survival was poor, the strongest determinant was preprocedural TIMI flow. Future cardiovascular cohort studies of long-term mortality should consider the impact of non-cardiovascular deaths.

https://doi.org/10.1136/heartjnl-2015-308739

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