Original Investigation
Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

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Abstract

Background

Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown.

Objectives

The goal of this study was to describe the association between time and cause of death in patients with STEMI undergoing primary PCI.

Methods

A centralized civil registration system, patient files, and public disease and death cause registries with an accurate record linkage were used to trace time and cause of death in 2,804 consecutive patients with STEMI (age 63 ± 13 years, 72% males) treated with primary PCI.

Results

Patients were followed up for a median of 4.7 years. During a total of 13,447 patient-years, 717 patients died. Main causes of death within the first 30 days were cardiogenic shock and anoxic brain injury after cardiac arrest. Age, culprit vessel size and flow, and the presence of heart failure and diabetes were independent predictors of mortality. After 30 days, the annual cardiac mortality rate was <1.5%. Causes of death beyond 30 days were noncardiac in 65% of cases (mainly malignancies and pulmonary diseases). The 30-day, 1-year, and 5-year all-cause (and cardiac) mortality rates were 7.9% (7.3%), 11.4% (8.4%), and 23.3% (13.8%), respectively.

Conclusions

Patients who survive the first month after an STEMI treated with primary PCI have an excellent prognosis, with a <1.5% annual risk of successive cardiac death. Noncardiac causes are responsible for the majority of later deaths in these patients.

Key Words

acute myocardial infarction
cause of death
follow-up study
percutaneous coronary intervention

Abbreviations and Acronyms

AMI
acute myocardial infarction
BMS
bare-metal stent(s)
CPR
civil personal registration (number)
DES
drug-eluting stent(s)
MODS
multiorgan dysfunction syndrome
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
TIMI
Thrombolysis In Myocardial Infarction
VSD
ventricular septal defect

Cited by (0)

This study was supported by the Research Fund at the Department of Cardiology, Rigshospitalet, University of Copenhagen. Dr. Clemmensen has a research contract with The Medicines Company; has received a research contract, speaking fees, and consulting fees from AstraZeneca; and has received a research contract, and advisory board and speaking fees from Eli Lilly and Daiichi Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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