title: Major adverse noncardiac events after PCI as predictors of long-term mortality.
abstract: BACKGROUND
  Studies of percutaneous coronary intervention (PCI) routinely report major adverse cardiovascular events (MACE), but not major adverse noncardiac events (MANE) after PCI. MANE, such as post-PCI bleeding and contrast nephropathy, adversely influence survival, but are not recognized as a standard composite of complications. We assessed the feasibility and prognostic utility of deriving a composite of MANE.
  
  
  METHODS
  In 985 consecutive patients who underwent PCI, we estimated the incidence and prognostic impact of in-hospital MACE (myocardial infarction [MI] target vessel revascularization, or stroke) and MANE (defined as thrombolysis in myocardial infarction [TIMI], bleeding [major or minor], or contrast nephropathy) and their impact on long-term survival.
  
  
  RESULTS
  The incidence of MANE was >6-fold greater than MACE (9.5% vs 1.5%). Independent correlates of MANE included age, female gender, peripheral vascular disease, lower left ventricular ejection fraction, and use of an intraaortic balloon pump (IABP) during PCI. Of 973 patients who survived the index hospitalization, death occurred in 169(17%) at a median follow-up of 4.0 years. MANE (but not MACE) showed a significant relation with survival; 34 of 85 patients with MANE compared to 135 of 888 patients without MANE died during follow-up (40% vs 15%, log-rank P < 0.0001). After adjustment for several baseline clinical features, the occurrence of MANE was independently associated with a significant increase in long-term mortality (adjusted hazards ratio [HR]= 1.72, CI = 1.05-2.83) and myocardial infarction (adjusted HR = 3.43, CI = 1.55-7.58).
  
  
  CONCLUSIONS
  After PCI, MANE are common and carry grave long-term prognostic significance. Our findings emphasize the need to monitor and report MANE, in addition to MACE, in PCI-related trials.
authors.affiliation: Guthrie Clinic, One Guthrie Square, Sayre, PA 18840, USA. harjai_kishore@guthrie.org
authors.forename: Kishore
authors.initials: K
authors.lastname: Harjai
authors.forename: Chetan
authors.initials: C
authors.lastname: Shenoy
authors.forename: Amol
authors.initials: A
authors.lastname: Raizada
authors.forename: Manivel
authors.initials: M
authors.lastname: Eswaran
authors.forename: Subasit
authors.initials: S
authors.lastname: Acharji
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Sattur
authors.forename: Pamela
authors.initials: P
authors.lastname: Orshaw
authors.forename: Srinivas
authors.initials: S
authors.lastname: Devarakonda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D010043:Outcome and Process Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000401:mortality* / Q000628:therapy*
chemical_list: D003287:Contrast Media