Ten-year mortality risk of patients undergoing elective PCI: long-term follow-up of the GENetic Determinants of Restenosis (GENDER) study

Verschuren, Jeffrey J. W.; Trompet, Stella; Tio, René A.; Winter, Robert J.; Doevendans, Pieter A.; Jukema, J. Wouter

doi:10.1007/s12471-012-0370-y

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…In addition, the statin therapy in patients with CAD may contribute to the lower rate of cancer death [ 53 ]. Similar results, a lower death rate from cancer and a higher rate of cardiovascular deaths were reported by the authors of the GENetic DEterminants of Restenosis (GENDER) study, who also compared CAD patients after elective PCI and the general population [ 54 ].…”

Section: Discussionsupporting

confidence: 80%

Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy

et al. 2016

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BackgroundAge is a strong predictor of survival in patients with coronary artery disease. In elder patients with increasing co-morbidities percutaneous coronary intervention (PCI) is associated with more complications and worse outcome. The calculation of relative survival rates adjusts for the “background” mortality in the general population by correcting for age and gender. We analyzed if elder patients after elective PCI have a worse relative survival compared to younger patient groups.MethodsA total of 8,342 patients who underwent elective PCI at two high volume centers between 1998 and 2009 were analyzed.ResultsThe survival of our patients after PCI (observed survival) was slightly lower compared to the general population (expected survival) resulting in a slightly decreasing relative survival curve. In a multivariate Cox regression model age amongst others was a strong predictor of survival. Stratifying patients according to their age the relative survival curves of younger patients (Quartile 1: <58 years; 2,046 patients), elder patients (Quartile 3: 66–73 years; 2,090 patients) and very old patients (Quartile 4: >73 years; 2,307 patients) were similar. The relative survival of mid-aged patients (Quartile 2: 58–65 years; 1,899 patients) was better than that of all other patient groups. The profile of cardiovascular risk factors differs between the various groups resulting in different composition and burden of coronary plaques in an optical coherence tomography sub-study.ConclusionPatients after elective PCI have a slightly worse long-term survival compared to the age- and sex-matched general population. This is also true for different groups of age except for mid-aged patients between 58 and 63 years. Elder patients between 66 and 73 years and above 73 years have a similar relative survival compared to younger patients below 58 years, and might therefore have similar benefit from elective PCI.

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Section: Discussionsupporting

confidence: 80%

Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy

et al. 2016

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“…Despite previous apprehension concerning drug-eluting stents (DES), they have turned out to be safe and efficient, also in the treatment of patients with acute coronary syndromes [ 11 ]. DES have significantly limited restenosis, which potentially may improve the prognosis of patients; however, data concerning the influence of restenosis on the mortality are equivocal [ 12 , 13 ]. Nevertheless, it seems that the presence of coronary heart disease itself and its advancement are more important in the prognosis than the appearance of restenosis, which can be effectively treated today [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…DES have significantly limited restenosis, which potentially may improve the prognosis of patients; however, data concerning the influence of restenosis on the mortality are equivocal [ 12 , 13 ]. Nevertheless, it seems that the presence of coronary heart disease itself and its advancement are more important in the prognosis than the appearance of restenosis, which can be effectively treated today [ 13 ]. We did not evaluate the influence of the type of stent on mortality in our study.…”

Section: Discussionmentioning

confidence: 99%

Significant narrowing of the circumflex artery leads to worse outcomes than right coronary artery narrowing in patients with anterior myocardial infarction treated invasively

et al. 2015

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BackgroundOcclusion of the circumflex artery (Cx) often does not present signs in the ECG. It can lead to delayed angiography during ST-elevation myocardial infarction (STEMI). The aim of this analysis was to determine if Cx narrowing is related to diverse outcomes in comparison with right coronary artery (RCA) stenosis in patients with STEMI, treated with percutaneous coronary intervention (PCI) of the left descending artery (LAD).Methods and resultsInclusion criteria were as follows: first STEMI treated with PCI of the LAD and additional significant (≥ 70 %) Cx or RCA narrowing—two-vessel disease. A total of 234 consecutive patients with STEMI were included. Total mortality was estimated during long-term follow-up, at mean 639 (± 224) days after STEMI. Patients with Cx narrowing constituted 46 % (N = 108) of the study population, and patients with RCA narrowing amounted to 54 % (N = 126). Patients with narrowing of the Cx had worse long-term outcomes in terms of mortality than patients with RCA narrowing (22 vs. 11 %, p < 0.05, respectively). Multiple regression analysis showed independent risk factors for death during long-term follow-up such as: age, ejection fraction and Cx narrowing.ConclusionSignificant Cx narrowing leads to worse outcomes than RCA narrowing in patients with STEMI treated with PCI of the LAD.

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“…The literature suggests that men with May 2021 574 stable coronary artery disease have similar long-term mortality to the general population, but women have a higher mortality. 41,42 This was accounted for by applying a hazard ratio of 1.39 to female life table values. Finally, we assumed that patients requiring TVR had a slightly higher risk of mortality compared with those with no events, 24 and that those with previous MI had an even greater risk of recurrent MI or death.…”

Section: Data Sourcesmentioning

confidence: 99%

Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: A Health Economic Analysis

Zhou

Liew

Duffy

et al. 2021

Circ: Cardiovascular Quality and Outcomes

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Background: There is increasing evidence that use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes compared with angiography guidance alone. However, concern regarding the cost-effectiveness of IVUS has limited use of this technology worldwide. In this study, we aimed to evaluate the cost-effectiveness of IVUS-guided PCI compared with angiography-guided PCI in patients undergoing drug-eluting stent implantation. Methods: A decision-analytic Markov model was constructed to compare the cost-effectiveness of IVUS to angiography guidance from the Australian healthcare system perspective. Procedure-related morbidity and mortality were estimated from the literature. Costs were obtained from Australian sources. The population of interest was all-comers undergoing PCI with drug-eluting stent. Outcomes of interest included costs, life-expectancy, and quality-adjusted life years (QALYs) for both treatment groups. Results: In the base case, IVUS guidance was cost-effective compared with angiography guidance alone. With 5% annual discounting, IVUS was associated with increased lifetime costs of Australian dollars (AUD) $823 (USD $597) per person and benefits of 0.04 life years and 0.05 QALYs compared with angiography, yielding an incremental cost-effectiveness ratio of AUD $17 539 (USD $12 730) per QALY gained. Results were robust to sensitivity analyses, with IVUS being cost-effective in 99% of 10 000 Monte Carlo iterations assuming a willingness-to-pay threshold of AUD $50 000 per QALY gained. In a worst-case scenario analysis, IVUS remained the cost-effective option, with an ICER of AUD $36 651 (USD $26 601) per QALY gained. Exploratory subgroup analysis revealed that cost-effectiveness may be greatest among patients with left main and complex coronary lesions. Conclusions: Use of IVUS guidance during PCI is likely to be cost-effective compared with angiography guidance alone among patients undergoing drug-eluting stent implantation.

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Ten-year mortality risk of patients undergoing elective PCI: long-term follow-up of the GENetic Determinants of Restenosis (GENDER) study

Cited by 4 publications

References 11 publications

Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy

Outcome after Elective Percutaneous Coronary Intervention Depends on Age in Patients with Stable Coronary Artery Disease – An Analysis of Relative Survival in a Multicenter Cohort and an OCT Substudy

Significant narrowing of the circumflex artery leads to worse outcomes than right coronary artery narrowing in patients with anterior myocardial infarction treated invasively

Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: A Health Economic Analysis

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