CAUSE OF DEATH ANALYSIS IN THE NHLBI PTCA REGISTRY - RESULTS AND CONSIDERATIONS FOR EVALUATING LONG-TERM SURVIVAL AFTER CORONARY INTERVENTIONS

Objectives. We examined cause of death in relation to age, length of f ollow-up and other baseline characteristics in patients in the 1985-19 86 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty (NHLBI PTCA) Registry. Background. The manner in which cardiac versus noncardiac mortality of patients,vith coronary r evascularization varies in relation to patient and study characteristi cs has not been well documented. Methods. Cause of death determined fr om a review of 5 years of annual follow-up forms and death certificate s was analyzed in 2,127 patients who had coronary angioplasty (mean ag e 57.6 years) without acute myocardial infarction. Results. Within 5 y ears of the initial procedure, there were 205 deaths (9.6%), with 52.7 % attributed to cardiac causes. Patients with a low baseline ejection fraction, history of hypertension, previous bypass surgery, previous m yocardial infarction, inoperable or high surgical risk or multivessel disease had significantly higher 5-year cardiac mortality. Patients wi th a history of diabetes, congestive heart failure or severe concomita nt noncardiac disease had higher rates of both cardiac and noncardiac mortality. As length of follow-up increased, older patients died of no ncardiac causes more often than cardiac causes. Age greater than or eq ual to 65 years was a strong independent predictor of 5 year noncardia c mortality (p < 0.001), but not cardiac mortality (p = 0.08). Conclus ions. All-cause mortality rates mag be high in elderly revascularized patients, yet cardiac mortality may be less than that expected because of a high risk of noncardiac death. Although all-cause mortality is a more reliable end point than cause-specific mortality, both cardiac a nd all-cause mortality should be considered in coronary intervention s tudies involving older patients and long-term follow-up. (C) 1997 by t he American College of Cardiology.