Original title: Trends in cause of death after percutaneous coronary intervention. Reference: Spoon DB et al. Circulation. 2014; Epub ahead of print.

This retrospective study evaluated the specific cause of death in 19077patients who received angioplasty in a center between 1991 and 2008. To perform the analysis, the track was divided into three time periods: 1991-1996, 1997-2002, and 2003-2008. From all patients included, 6998 died at following up (37%, 4.48/100 patient-year) within which could determine the specific cause of death in 6857 (98.1 %). Cardiac mortality recorded for the period 1991-1996 was 9.8 %, decreasing to 7.4 % for 1997-2002 and finally 6.6 % for the last period, which means a 33% decrease in cardiac death within 5 years angioplasty index. Concomitantly, an increase of 57 % in the death of noncardiac causes (7.1 %, 8.5 % and 11.2 % respectively) was observed. Currently only 36.8% of patients receiving angioplasty die from cardiac causes, showing a similar trend in the different subgroups as elderly , magnitude of coronary disease and an indication for angioplasty (chronic angina or acute coronary syndrome). After adjusting all baseline variables, a decrease of 50 % in cardiac mortality over the years and a similar rate of non-cardiac deaths were observed. The decrease in cardiac death was due to a lower rate of fatal heart attacks and sudden death       (p < 0.001) but not heart failure deaths (p = 0.85). The increase in non- cardiac deaths was mainly due to cancer and other chronic diseases (p < 0.001).

Conclusion

This work showed a marked change in the last two decades regarding the cause of death in patients who received angioplasty (mainly cardiac to mainly non-cardiac). The reduction in cardiac death was independent of changes in baseline characteristics observed in the same period of time.

Editorial comment

The time periods for the division were chosen to correspond approximately to changes in the way angioplasties were performed: balloon angioplasty and provisional stenting in 1991-1996, routine angioplasty with conventional stent in 1997-2002 and conventional angioplasty with pharmacological stent 2003-2008. It is noteworthy that a death by heart failure has remained stable over time despite all pharmacological and devices advances.

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