title: Trends in cause of death after percutaneous coronary intervention.
abstract: BACKGROUND
  The impact of changing demographics on causes of long-term death after percutaneous coronary intervention (PCI) remains incompletely defined.
  
  
  RESULTS
  We evaluated trends in cause-specific long-term mortality after index PCI performed at a single center from 1991 to 2008. Deaths were ascertained by scheduled prospective surveillance. Cause was determined via telephone interviews, medical records, autopsy reports, and death certificates. Competing-risks analysis of cause-specific mortality was performed using 3 time periods of PCI (1991-1996, 1997-2002, and 2003-2008). Final follow-up was December 31, 2012. A total of 19 077 patients survived index PCI hospitalization, of whom 6988 subsequently died (37%, 4.48 per 100 person-years). Cause was determined in 6857 (98.1%). Across 3 time periods, there was a 33% decline in cardiac deaths at 5 years after PCI (incidence: 9.8%, 7.4%, and 6.6%) but a 57% increase in noncardiac deaths (7.1%, 8.5%, and 11.2%). Only 36.8% of deaths in the recent era were cardiac. Similar trends were observed regardless of age, extent of coronary disease, or PCI indication. After adjustment for baseline variables, there was a 50% temporal decline in cardiac mortality but no change in noncardiac mortality. The decline in cardiac mortality was driven by fewer deaths from myocardial infarction/sudden death (P<0.001) but not heart failure (P=0.85). The increase in noncardiac mortality was primarily attributable to cancer and chronic diseases (P<0.001).
  
  
  CONCLUSIONS
  This study found a marked temporal switch from predominantly cardiac to predominantly noncardiac causes of death after PCI over 2 decades. The decline in cardiac mortality was independent of changes in baseline clinical characteristics. These findings have implications for patient care and clinical trial design.
authors: Divisions of Cardiovascular Diseases (D.B.S., P.J.P., M.S., D.R.H., B.J.G., C.S.R., R.D.S., R.G.) and Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Diseases (I.D.M.), Mayo Clinic, Jacksonville, FL.
authors: Daniel B
authors: DB
authors: Spoon
authors: Peter J
authors: PJ
authors: Psaltis
authors: Mandeep
authors: M
authors: Singh
authors: David R
authors: DR
authors: Holmes
authors: Bernard J
authors: BJ
authors: Gersh
authors: Charanjit S
authors: CS
authors: Rihal
authors: Ryan J
authors: RJ
authors: Lennon
authors: Issam D
authors: ID
authors: Moussa
authors: Robert D
authors: RD
authors: Simari
authors: Rajiv
authors: R
authors: Gulati
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy; D017677:Age Distribution; D000368:Aged; D060050:Angina, Stable / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001014:Aortic Aneurysm / Q000401:mortality; D002423:Cause of Death / Q000639:trends*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D009369:Neoplasms / Q000401:mortality; D020521:Stroke / Q000401:mortality
keywords: cardiovascular diseases; coronary disease; death; percutaneous coronary intervention