Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/37059
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dc.contributor.authorAlabas, O.-
dc.contributor.authorRutherford, Mark-
dc.contributor.authorHall, M.-
dc.contributor.authorBrogan, R. A.-
dc.contributor.authorAlmudarra, S.-
dc.contributor.authorRutherford, M. J.-
dc.contributor.authorDondo, T. B.-
dc.contributor.authorFeltbower, R.-
dc.contributor.authorCurzen, N.-
dc.contributor.authorde Belder, M.-
dc.contributor.authorLudman, P.-
dc.contributor.authorGale, C. P.-
dc.contributor.authorNational Institute for Cardiovascular Outcomes Research-
dc.date.accessioned2016-03-15T14:45:50Z-
dc.date.available2016-12-10T02:45:09Z-
dc.date.issued2016-04-07-
dc.identifier.citationHeart, 2016, 102, pp. 1287-1295en
dc.identifier.issn1355-6037-
dc.identifier.urihttp://heart.bmj.com/content/102/16/1287en
dc.identifier.urihttp://hdl.handle.net/2381/37059-
dc.description.abstractObjective: For percutaneous coronary intervention (PCI) to the unprotected left main stem (UPLMS), there are limited long-term outcome data. We evaluated 5-year survival for UPLMS PCI cases taking into account background population mortality. Methods: A population-based registry of 10 682 cases of chronic stable angina (CSA), non-ST-segment elevation acute coronary syndrome (NSTEACS), ST-segment elevation myocardial infarction with (STEMI+CS) and without cardiogenic shock (STEMI−CS) who received UPLMS PCI from 2005 to 2014 were matched by age, sex, year of procedure and country to death data for the UK populace of 56.6 million people. Relative survival and excess mortality were estimated. Results: Over 26 105 person-years follow-up, crude 5-year relative survival was 93.8% for CSA, 73.1% for NSTEACS, 77.5% for STEMI−CS and 28.5% for STEMI+CS. The strongest predictor of excess mortality among CSA was renal failure (EMRR 6.73, 95% CI 4.06 to 11.15), and for NSTEACS and STEMI−CS was preprocedural ventilation (6.25, 5.05 to 7.75 and 6.92, 4.25 to 11.26, respectively). For STEMI+CS, the strongest predictor of excess mortality was preprocedural thrombolysis in myocardial infarction (TIMI) 0 flow (2.78, 1.87 to 4.13), whereas multivessel PCI was associated with improved survival (0.74, 0.61 to 0.90). Conclusions: Long-term survival following UPLMS PCI for CSA was high, approached that of the background populace and was significantly predicted by co-morbidity. For NSTEACS and STEMI−CS, the requirement for preprocedural ventilation was the strongest determinant of excess mortality. By contrast, among STEMI+CS, in whom survival was poor, the strongest determinant was preprocedural TIMI flow. Future cardiovascular cohort studies of long-term mortality should consider the impact of non-cardiovascular deathsen
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.rightsCopyright © 2016, the authors. Licensee: BMJ. Deposited with reference to the publisher’s archiving policy available on the SHERPA/RoMEO website.en
dc.subjectUnprotected left main stemen
dc.subjectpercutaneous coronary interventionen
dc.subjectrelative survivalen
dc.subjectexcess mortalityen
dc.subjectSTEMIen
dc.subjectNSTEACSen
dc.subjectchronic stable anginaen
dc.subjectcardiogenic shocken
dc.titleDeterminants of excess mortality following unprotected left main stem percutaneous coronary interventionen
dc.typeJournal Articleen
dc.identifier.doi10.1136/heartjnl-2015-308739-
dc.identifier.eissn1468-201X-
dc.description.statusPeer-revieweden
dc.description.versionPost-printen
dc.type.subtypeArticle-
pubs.organisational-group/Organisationen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGYen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicineen
pubs.organisational-group/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciencesen
dc.dateaccepted2016-03-09-
Appears in Collections:Published Articles, Dept. of Health Sciences

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