Researchers of a new study published in Circulation have observed a temporal switch during a 2-decade interval that suggests more long-term deaths after PCI are caused by noncardiac than cardiac causes.
The researchers noted that there is uncertainty surrounding the impact of changing demographics on mortality outcomes in PCI. In the current single-center study, they investigated trends in cause-specific long-term mortality in a cohort of 19,077 patients who had undergone index PCI.
Scheduled prospective surveillance was conducted to account for deaths. The researchers ascertained the cause of death via telephone interviews, medical records, autopsy reports and death certificates until final follow-up on Dec. 31, 2012.
Risk and mortality outcomes associated with PCI were reported for three time periods in which the intervention was used: 1991 to 1996, 1997 to 2002, and 2003 to 2008.
The mortality rate was 37%, which the researchers noted included 6,988 deaths, or 4.48 of 100 person-years. Cause of death was accurately reported in 6,857 patients, or 98.1% of the cohort.
The cardiac death rate at 5 years after intervention was 9.8% in the first time period, 7.4% in the second and 6.6% in the third, for an overall decrease of 33%. However, a 57% increase was reported for noncardiac deaths (1991-1996, 7.1%; 1997-2002, 8.5%; 2003-2008, 11.2%).
In the most recent era, the cardiac death rate was 36.8%.
These trends held across age groups, regardless of extent of coronary disease or PCI indication, according to the findings.
A 50% temporal decrease occurred in cardiac deaths after adjusting for baseline variables. However, there was no change in noncardiac death in this adjusted analysis.
Fewer deaths from MI or sudden death drove the decrease in cardiac mortality (P<.001). However, this trend did not hold for HF (P=.85).
Increases in cancer and chronic diseases were the primary drivers of increases in noncardiac death (P<.001).
The researchers concluded that the results may impact clinical trial design moving forward.
“We found that patients with established heart disease undergoing angioplasty and stenting in the modern era have about a one in three chance of dying from their heart disease, and a two in three chance of dying from noncardiac diseases in the long term,” Rajiv Gulati, MD, PhD, senior author and interventional cardiologist at Mayo Clinic, Rochester, Minn., said in a press release. “These results show that we have an opportunity to focus on the noncardiac diseases in these patients — to treat the patient holistically. But it also gives us the opportunity to identify and target those patients who are at risk of dying from heart disease.”
Disclosure: The researchers report no relevant financial disclosures.