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    Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes?

    Access Status
    Open access via publisher
    Authors
    Biswas, S.
    Andrianopoulos, N.
    Papapostolou, S.
    Noaman, S.
    Duffy, S.
    Lefkovits, J.
    Brennan, Angela
    Walton, A.
    Shaw, J.
    Ajani, A.
    Clark, D.
    Freeman, M.
    Hiew, C.
    Oqueli, E.
    Reid, C.
    Stub, D.
    Chan, W.
    Date
    2018
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Biswas, S. and Andrianopoulos, N. and Papapostolou, S. and Noaman, S. and Duffy, S. and Lefkovits, J. and Brennan, A. et al. 2018. Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes?. European Heart Journal - Quality of Care and Clinical Outcomes. 4 (4): pp. 318-327.
    Source Title
    European Heart Journal - Quality of Care and Clinical Outcomes
    DOI
    10.1093/ehjqcco/qcy009
    ISSN
    2058-5225
    School
    School of Public Health
    Funding and Sponsorship
    http://purl.org/au-research/grants/nhmrc/1111170
    http://purl.org/au-research/grants/nhmrc/1045862
    http://purl.org/au-research/grants/nhmrc/1090302
    http://purl.org/au-research/grants/nhmrc/1052960
    URI
    http://hdl.handle.net/20.500.11937/71303
    Collection
    • Curtin Research Publications
    Abstract

    © The Author 2017. Aims The prognosis of patients undergoing percutaneous coronary intervention (PCI) for different subtypes of acute coronary syndromes (ACS) remains unclear. We compared short- and long-term mortality in patients undergoing PCI for unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). Methods and results This was a retrospective cohort study of 13 184 patients (5966 STEMI, 5307 NSTEMI, and 1911 UA) undergoing PCI between 1 January 2005 and 30 November 2013 in a multi-centre registry. Clinical and procedural characteristics, as well as outcomes, were compared by ACS subtype. Long-term all-cause mortality data were obtained via linkage to the National Death Index (NDI). Patients with STEMI compared with NSTEMI and UA were younger (62.9 ± 12.8 vs. 64.7 ± 12.5 vs. 65.5 ± 11.8 years; P < 0.01), had fewer comorbidities including diabetes, heart failure, and previous myocardial infarction (all P < 0.01). Procedural success was similar across all groups (P = 0.54). In-hospital, 30-day and 1-year all-cause mortality increased significantly from UA to NSTEMI to STEMI patients (1-year mortality 2.5% vs. 4.5% vs. 8.7%; P < 0.01). Kaplan-Meier survival estimates showed increased early mortality in the STEMI group (log-rank P < 0.01). However, after approximately 8.2 years, survival was similar across all groups. In a proportional-odds model using flexible parametric survival modelling, ACS subtype was not an independent predictor of NDI-linked mortality [UA: odds ratio (OR) 0.85, 95% CI 0.71-1.02; STEMI: OR 1.01, 95% confidence interval (CI) 0.88-1.16; NSTEMI as reference category]. Conclusion Despite disparate baseline characteristics and differences in short-term mortality, long-term mortality was similar across the spectrum of ACS treated by PCI and contemporary medical therapy.

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