Prognostic impact of subsequent acute coronary syndrome and unplanned revascularization on long-term mortality after an index percutaneous coronary intervention: A report from a Japanese multicenter registry

Taku Inohara, Shun Kosaka, Hiroaki Miyata, Mitsuaki Sawano, Ikuko Ueda, Yuichiro Maekawa, Keiichi Fukuda, Philip G. Jones, David J. Cohen, Zhenxiang Zhao, John A. Spertus, Kim G. Smolderen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere006529
JournalJournal of the American Heart Association
Volume6
Issue number11
DOIs
Publication statusPublished - 2017 Nov 1

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Percutaneous Coronary Intervention
Acute Coronary Syndrome
Registries
Mortality
Unstable Angina
Confidence Intervals
Survival
Clinical Trials
Proportional Hazards Models
Teaching Hospitals
Infarction
Odds Ratio
Incidence

Keywords

  • Acute aortic syndrome
  • Composite end point
  • Percutaneous coronary intervention
  • Revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic impact of subsequent acute coronary syndrome and unplanned revascularization on long-term mortality after an index percutaneous coronary intervention : A report from a Japanese multicenter registry. / Inohara, Taku; Kosaka, Shun; Miyata, Hiroaki; Sawano, Mitsuaki; Ueda, Ikuko; Maekawa, Yuichiro; Fukuda, Keiichi; Jones, Philip G.; Cohen, David J.; Zhao, Zhenxiang; Spertus, John A.; Smolderen, Kim G.

In: Journal of the American Heart Association, Vol. 6, No. 11, e006529, 01.11.2017.

Research output: Contribution to journalArticle

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abstract = "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.",
keywords = "Acute aortic syndrome, Composite end point, Percutaneous coronary intervention, Revascularization",
author = "Taku Inohara and Shun Kosaka and Hiroaki Miyata and Mitsuaki Sawano and Ikuko Ueda and Yuichiro Maekawa and Keiichi Fukuda and Jones, {Philip G.} and Cohen, {David J.} and Zhenxiang Zhao and Spertus, {John A.} and Smolderen, {Kim G.}",
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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 - Kosaka, 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.

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

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