%0 Journal Article
%T Relative survival and excess mortality following primary percutaneous coronary intervention for ST
%A Chris P Gale
%A Mamas A Mamas
%A Mark de Belder
%A Marlous Hall
%A Nick Curzen
%A Oras Alabas
%A Paul D Baxter
%A Peter F Ludman
%A Phillip D Batin
%A Richard A Brogan
%A Sami Almudarra
%A Tatendashe B Dondo
%J European Heart Journal: Acute Cardiovascular Care
%@ 2048-8734
%D 2019
%R 10.1177/2048872617710790
%X High survival rates are commonly reported following primary percutaneous coronary intervention for ST-elevation myocardial infarction, with most contemporary studies reporting overall survival. The aim of this study was to describe survival following primary percutaneous coronary intervention for ST-elevation myocardial infarction corrected for non-cardiovascular deaths by reporting relative survival and investigate clinically significant factors associated with poor long-term outcomes. Using the prospective UK Percutaneous Coronary Intervention registry, primary percutaneous coronary intervention cases (n=88,188; 2005每2013) were matched to mortality data for the UK populace. Crude five-year relative survival was 87.1% for the patients undergoing primary percutaneous coronary intervention and 94.7% for patients <55 years. Increasing age was associated with excess mortality up to four years following primary percutaneous coronary intervention (56每65 years: excess mortality rate ratio 1.61, 95% confidence interval 1.46每1.79; 66-75 years: 2.49, 2.26每2.75; >75 years: 4.69, 4.27每5.16). After four years, there was no excess mortality for ages 56每65 years (excess mortality rate ratio 1.27, 0.95每1.70), but persisting excess mortality for older groups (66每75 years: excess mortality rate ratio 1.72, 1.30每2.27; >75 years: 1.66, 1.15每2.41). Excess mortality was associated with cardiogenic shock (excess mortality rate ratio 6.10, 5.72每6.50), renal failure (2.52, 2.27每2.81), left main stem stenosis (1.67, 1.54每1.81), diabetes (1.58, 1.47每1.69), previous myocardial infarction (1.52, 1.40每1.65) and female sex (1.33, 1.26每1.41); whereas stent deployment (0.46, 0.42每0.50) especially drug eluting stents (0.27, 0.45每0.55), radial access (0.70, 0.63每0.71) and previous percutaneous coronary intervention (0.67, 0.60每0.75) were protective. Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, long-term cardiovascular survival is excellent. Failure to account for non-cardiovascular death may result in an underestimation of the efficacy of primary percutaneous coronary intervention
%K Primary percutaneous coronary intervention
%K ST-elevation myocardial infarction
%K relative survival
%K excess mortality
%K cardiogenic shock
%K renal insufficiency
%K radial access
%K risk stratification
%U https://journals.sagepub.com/doi/full/10.1177/2048872617710790