Major adverse noncardiac events after PCI as predictors of long-term mortality.
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.
Harjai
Kishore
K
Guthrie Clinic, One Guthrie Square, Sayre, PA 18840, USA. harjai_kishore@guthrie.org
Shenoy
Chetan
C
Raizada
Amol
A
Eswaran
Manivel
M
Acharji
Subasit
S
Sattur
Sudhakar
S
Orshaw
Pamela
P
Devarakonda
Srinivas
S
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*
D003287:Contrast Media