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

David R. Holmes, Kevin E. Kip, Sheryl F. Kelsey, Katherine M. Detre, Allan D. Rosen

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

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 ≤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.

Original languageEnglish (US)
Pages (from-to)881-887
Number of pages7
JournalJournal of the American College of Cardiology
Volume30
Issue number4
DOIs
StatePublished - Oct 1997

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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