Cause of death analysis in the NHLBI PTCA Registry: results and considerations for evaluating long-term survival after coronary interventions

Mayo Clinic, Rochester, Minnesota, USA.

OBJECTIVES: We examined cause of death in relation to age, length of follow-up and other baseline characteristics in patients in the 1985-1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty (NHLBI PTCA) Registry. BACKGROUND: The manner in which cardiac versus noncardiac mortality of patients with coronary revascularization varies in relation to patient and study characteristics has not been well documented. METHODS: Cause of death determined from a review of 5 years of annual follow-up forms and death certificates was analyzed in 2,127 patients who had coronary angioplasty (mean age 57.6 years) without acute myocardial infarction. RESULTS: Within 5 years of the initial procedure, there were 205 deaths (9.6%), with 52.7% attributed to cardiac causes. Patients with a low baseline ejection fraction, history of hypertension, previous bypass surgery, previous myocardial infarction, inoperable or high surgical risk or multivessel disease had significantly higher 5-year cardiac mortality. Patients with a history of diabetes, congestive heart failure or severe concomitant noncardiac disease had higher rates of both cardiac and noncardiac mortality. As length of follow-up increased, older patients died of noncardiac causes more often than cardiac causes. Age > or = 65 years was a strong independent predictor of 5-year noncardiac mortality (p < 0.001), but not cardiac mortality (p = 0.08). CONCLUSIONS: All-cause mortality rates may be high in elderly revascularized patients, yet cardiac mortality may be less than that expected because of a high risk of noncardiac death. Although all-cause mortality is a more reliable end point than cause-specific mortality, both cardiac and all-cause mortality should be considered in coronary intervention studies involving older patients and long-term follow-up.

This article has been cited by other articles:

				C. A. Herzog, J. W. Strief, A. J. Collins, and D. T. Gilbertson Cause-specific mortality of dialysis patients after coronary revascularization: why don't dialysis patients have better survival after coronary intervention? Nephrol. Dial. Transplant., August 1, 2008; 23(8): 2629 - 2633. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr, L. J. Kim, M. M. Brooks, K. E. Kip, H. V. Schaff, K. M. Detre, R. L. Frye, and Bypass Angioplasty Revascularization Investigation The effect of coronary artery bypass grafting on specific causes of long-term mortality in the Bypass Angioplasty Revascularization Investigation J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 38 - 46. [Abstract] [Full Text] [PDF]

				J. S. Hochman, L. A. Sleeper, J. G. Webb, V. Dzavik, C. E. Buller, P. Aylward, J. Col, H. D. White, and for the SHOCK Investigators Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA, June 7, 2006; 295(21): 2511 - 2515. [Abstract] [Full Text] [PDF]

				A. J. Lansky, J. S. Hochman, P. A. Ward, G. S. Mintz, R. Fabunmi, P. B. Berger, G. New, C. L. Grines, C. G. Pietras, M. J. Kern, et al. Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women: A Statement for Healthcare Professionals From the American Heart Association Circulation, February 22, 2005; 111(7): 940 - 953. [Abstract] [Full Text] [PDF]

				A. W. Chan, M. J. Quinn, D. L. Bhatt, D. P. Chew, D. J. Moliterno, E. J. Topol, and S. G. Ellis Mortality benefit of beta-blockade after successful elective percutaneous coronary intervention J. Am. Coll. Cardiol., August 21, 2002; 40(4): 669 - 675. [Abstract] [Full Text] [PDF]

				S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]

				S. Baldus, R. Koster, M. Elsner, D. H. Walter, R. Arnold, W. Auch-Schwelk, J. Berger, M. Rau, T. Meinertz, A. M. Zeiher, et al. Treatment of Aortocoronary Vein Graft Lesions With Membrane-Covered Stents : A Multicenter Surveillance Trial Circulation, October 24, 2000; 102(17): 2024 - 2027. [Abstract] [Full Text] [PDF]

				S. E. Kimmel, A. R. Localio, C. Brensinger, C. Miles, J. Hirshfeld, H. L. Haber, and B. L. Strom Effects of Coronary Stents on Cardiovascular Outcomes in Broad-Based Clinical Practice Arch Intern Med, September 25, 2000; 160(17): 2593 - 2599. [Abstract] [Full Text] [PDF]

				S. B. King III Percutaneous transluminal coronary angioplasty J. Am. Coll. Cardiol., April 1, 2000; 35(5_Suppl_B): 35B - 37B. [PDF]

				S. B. King III Percutaneous transluminal coronary angioplasty J. Am. Coll. Cardiol., September 1, 1999; 34(3): 615 - 617. [Full Text] [PDF]