title: Acute coronary syndrome and stable coronary artery disease: are they so different? Long-term outcomes in a contemporary PCI cohort.
abstract: BACKGROUND
  Patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) are known to have poorer short-term prognosis compared to stable coronary artery (CAD) patients undergoing elective PCI. Few studies have made direct comparison of long-term mortality between ACS and stable CAD patients undergoing PCI. The aim of our study was to compare the long-term mortality following PCI between patients with ACS and those with stable CAD.
  
  
  METHODS
  We examined consecutive patients undergoing PCI with stenting at a tertiary referral hospital. Clinical, angiographic and biochemical data were collected and analysed. The primary outcome was all-cause mortality retrieved from the Statewide Death Registry database.
  
  
  RESULTS
  Included were 1923 consecutive PCI patients (970 stable CAD and 953 ACS). The mean follow-up time was 4.1 years ± 1.8 years. In-hospital mortality was 1.4% overall, seen exclusively in patients with ACS (n=28, 2.9%). Post-discharge mortality was 6.7% among patients with stable CAD and 10.5% for ACS (P<0.01). Multivariate predictors of post-discharge deaths for both groups included age (HR 1.08 per year, P<0.001) and impaired renal function (HR 2.49, P<0.001). Following adjustment for these factors, an ACS indication for PCI was not associated with greater post-discharge mortality (adjusted HR 1.18: 0.85-1.64, P=0.32).
  
  
  CONCLUSIONS
  Patients undergoing PCI following an ACS have higher long-term mortality to those with stable CAD, which is potentially explained by a greater prevalence of comorbidities. This suggests that for the ACS population, contemporary interventional and medical management strategies may effectively and specifically counter the adverse prognostic impact of coronary instability and myocardial damage.
authors.affiliation: Department of Cardiology, Concord Repatriation General Hospital, The University of Sydney, New South Wales, Australia.
authors.forename: R F
authors.initials: RF
authors.lastname: Alcock
authors.forename: A S C
authors.initials: AS
authors.lastname: Yong
authors.forename: A C C
authors.initials: AC
authors.lastname: Ng
authors.forename: V
authors.initials: V
authors.lastname: Chow
authors.forename: C
authors.initials: C
authors.lastname: Cheruvu
authors.forename: B
authors.initials: B
authors.lastname: Aliprandi-Costa
authors.forename: H C
authors.initials: HC
authors.lastname: Lowe
authors.forename: L
authors.initials: L
authors.lastname: Kritharides
authors.forename: D B
authors.initials: DB
authors.lastname: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000639:trends; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome