TY - JOUR
T1 - Prognostic impact of subsequent acute coronary syndrome and unplanned revascularization on long-term mortality after an index percutaneous coronary intervention
T2 - A report from a Japanese multicenter registry
AU - Inohara, Taku
AU - Kohsaka, Shun
AU - Miyata, Hiroaki
AU - Sawano, Mitsuaki
AU - Ueda, Ikuko
AU - Maekawa, Yuichiro
AU - Fukuda, Keiichi
AU - Jones, Philip G.
AU - Cohen, David J.
AU - Zhao, Zhenxiang
AU - Spertus, John A.
AU - Smolderen, Kim G.
N1 - Funding Information:
The present study was funded by the Grants-in-Aid for Scientific Research from Japan Society for the Promotion of Science (Grant Nos. 25460630 and 25460777) and unrestricted research grant from Eli Lilly and Company. The funders had no role in the conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation or approval of the article.
Funding Information:
Dr Kohsaka received lecture fees from Pfizer Japan Inc and a research grant for Department of Cardiology, Keio University School of Medicine from Bayer Yakuhin Ltd. Dr Fukuda received a research grant for Department of Cardiology, Keio University School of Medicine from Bayer Yakuhin Ltd. Dr Spertus is the primary investigator of a contract from the ACCF to analyze the NCDR data. He also has an equity interest in Health Outcomes Sciences. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2017 The Authors.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background--Whereas composite end points are often used in clinical trials of percutaneous coronary interventions (PCI), the impact of individual components on subsequent survival is incompletely defined. We evaluated the association of subsequent acute coronary syndromes (ACS) and unplanned coronary revascularization post-PCI with long-term survival. Methods and Results--From 2009 to 2011, the KiCS-PCI (Keio interhospital Cardiovascular Studies) consecutively enrolled patients undergoing PCI in14 Japanese teaching hospitals.Weidentified patientswhoexperiencedACSor unplanned coronary revascularization following their index PCI and compared subsequent survival during the 2-year follow-up period using propensity-matched cohorts of patients who did and did not experience these events. Cox proportional hazard models were used to assess 2-year all-cause mortality. Because unstable anginais less severe than acutemyocardial infarction,wealsogeneratedaseparate propensity-matchedcohort forUA post-PCI. Among 3348 PCI patients (mean age, 67.5±10.7 years; 79.7% male), 214 (6.4%) experienced a subsequent ACS (168 events [78.5%]wereunstable angina),and198(5.9%)underwent unplannedrevascularization. In the propensity-matchedcohorts, patients with a subsequent ACS admission had an increased risk of mortality as compared with those without (hazard ratio, 4.73; 95% confidence interval=1.35-16.6; P=0.015), whereas those with an unplanned revascularization did not have significantly higher risk (hazard ratio, 2.97; 95% confidence interval=0.57-14.3; P=0.19).Among unstable angina events, no association with mortality was observed (hazard ratio, 1.39; 95% confidence interval=0.48-4.00; P=0.54). Conclusions--In the KiCS-PCI registry, the incidence of a subsequent ACS was associated with higher mortality, but this association was less apparent after unplanned coronary revascularization or unstable angina. The prognostic implications of different outcomes in a composite end point should be considered when interpreting the results of clinical trials in PCI.
AB - Background--Whereas composite end points are often used in clinical trials of percutaneous coronary interventions (PCI), the impact of individual components on subsequent survival is incompletely defined. We evaluated the association of subsequent acute coronary syndromes (ACS) and unplanned coronary revascularization post-PCI with long-term survival. Methods and Results--From 2009 to 2011, the KiCS-PCI (Keio interhospital Cardiovascular Studies) consecutively enrolled patients undergoing PCI in14 Japanese teaching hospitals.Weidentified patientswhoexperiencedACSor unplanned coronary revascularization following their index PCI and compared subsequent survival during the 2-year follow-up period using propensity-matched cohorts of patients who did and did not experience these events. Cox proportional hazard models were used to assess 2-year all-cause mortality. Because unstable anginais less severe than acutemyocardial infarction,wealsogeneratedaseparate propensity-matchedcohort forUA post-PCI. Among 3348 PCI patients (mean age, 67.5±10.7 years; 79.7% male), 214 (6.4%) experienced a subsequent ACS (168 events [78.5%]wereunstable angina),and198(5.9%)underwent unplannedrevascularization. In the propensity-matchedcohorts, patients with a subsequent ACS admission had an increased risk of mortality as compared with those without (hazard ratio, 4.73; 95% confidence interval=1.35-16.6; P=0.015), whereas those with an unplanned revascularization did not have significantly higher risk (hazard ratio, 2.97; 95% confidence interval=0.57-14.3; P=0.19).Among unstable angina events, no association with mortality was observed (hazard ratio, 1.39; 95% confidence interval=0.48-4.00; P=0.54). Conclusions--In the KiCS-PCI registry, the incidence of a subsequent ACS was associated with higher mortality, but this association was less apparent after unplanned coronary revascularization or unstable angina. The prognostic implications of different outcomes in a composite end point should be considered when interpreting the results of clinical trials in PCI.
KW - Acute aortic syndrome
KW - Composite end point
KW - Percutaneous coronary intervention
KW - Revascularization
UR - http://www.scopus.com/inward/record.url?scp=85034758666&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85034758666&partnerID=8YFLogxK
U2 - 10.1161/JAHA.117.006529
DO - 10.1161/JAHA.117.006529
M3 - Article
C2 - 29079567
AN - SCOPUS:85034758666
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e006529
ER -