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0002-9149/12/$ see front matter 2012 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.amjcard.2012.06.028
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Table 1
Baseline clinical characteristics between percutaneous coronary intervention (PCI) and medical therapy groups
Variable
Age (years)
Men
Smoker
Hypertension
Diabetes mellitus
Dyslipidemia
Chronic kidney disease
Myocardial infarction
Angina pectoris
Percutaneous coronary intervention
Coronary bypass
Heart failure
Stroke
Peripheral artery disease
Presentation data
Interval from symptom onset (hours)
Chest pain
Systolic blood pressure (mm Hg)
Diastolic blood pressure (mm Hg)
Heart rate (beats/min)
Killip class
I
II
Preinfarct angina pectoris
Q waves
Left bundle branch block
Anterior myocardial infarction
Left ventricular ejection fraction (%)
Laboratory findings
Total cholesterol (mg/dl)
Low-density lipoprotein cholesterol (mg/dl)
High-density lipoprotein cholesterol (mg/dl)
Triglycerides (mg/dl)
Creatinine (mg/dl)
Peak troponin I (ng/ml)
Glucose at admission (mg/dl)
High-sensitivity C-reactive protein at admission (mg/dl)
N-terminal pro-B-type natriuretic peptide at admission (pg/ml)
PCI
(n 1,889)
Medical Therapy
(n 455)
p Value
66 (5573)
1,314 (69.6%)
1,078 (57.1%)
1,021 (54.0%)
506 (26.8%)
193 (10.2%)
35 (1.9%)
86 (4.6%)
87 (4.6%)
75 (4.0%)
10 (0.5%)
18 (1.0%)
129 (6.8%)
17 (0.9%)
69 (5776)
269 (59.1%)
221 (48.6%)
236 (51.9%)
129 (28.4%)
42 (9.2%)
24 (5.3%)
46 (10.1%)
41 (9.0%)
34 (7.5%)
4 (0.9%)
32 (7.0%)
54 (11.9%)
12 (2.6%)
0.001
0.001
0.001
0.40
0.50
0.53
0.001
0.001
0.001
0.001
0.49
0.001
0.001
0.003
22 (1534)
1,521 (80.5%)
130 (110146)
80 (7090)
76 (6686)
23 (1635)
312 (68.6%)
130 (110150)
80 (7087)
78 (6892)
0.84
0.001
0.57
0.50
0.001
0.001
1,555 (82.3%)
334 (17.7%)
876 (46.4%)
372 (19.7%)
12 (0.6%)
830 (43.9%)
53 (4660)
338 (74.3%)
117 (25.7%)
199 (43.7%)
74 (16.3%)
8 (1.8%)
166 (36.5%)
53 (4460)
182 (157211)
114 (95141)
43 (3751)
104 (76152)
0.9 (0.81.1)
15 (539)
130 (109168)
1.2 (0.43.9)
1,020 (6831,291)
171 (143202)
108 (80128)
43 (3653)
102 (69132)
1.0 (0.81.3)
8 (217)
131 (108169)
1.2 (0.43.7)
1,020 (8571,854)
0.31
0.09
0.04
0.004
0.13
0.001
0.001
0.51
0.002
0.001
0.001
0.84
0.91
0.002
Continuous variables are presented as the median (interquartile range) and other data as n (%).
tricular arrhythmia, advanced atrioventricular block, systolic blood pressure 90 mm Hg, heart rate 100 beats/
min, or Killip class III-IV at presentation. We also excluded
patients who had undergone fibrinolysis. Of the 7,885 patients who presented within 72 hours after symptom onset,
2,640 patients presenting 12 to 72 hours were selected:
2,185 underwent PCI and 455 received conservative medical treatment. Of the 2,185 patients in the invasive cohort,
236 underwent immediate PCI (median interval from arrival
59 minutes), 60 underwent urgent PCI during conservative
treatment (median interval from arrival 68 hours), and 1,889
underwent elective PCI (median interval from arrival 23
hours). Because it was difficult to capture the fluctuation of
chest pain and/or ST-segment elevation from our registryto compensate for the potential selection bias associated with thiswe excluded patients receiving immediate
and urgent PCI, and compared the 12-month clinical out-
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Table 2
Characteristics of procedures, complications, and medical treatment during hospitalization between percutaneous coronary intervention (PCI) and medical
therapy groups
Variable
Procedure
Coronary angiography
Infarct-related artery
Left main
Left anterior descending
Left circumflex
Right coronary
Prepercutaneous coronary intervention Thrombolysis In Myocardial Infarction flow
0
1
2
3
Complications during hospitalization
Cardiogenic shock
Atrial fibrillation
Ventricular tachycardia/fibrillation
Advanced atrioventricular block
Cardiovascular resuscitation
Intra-aortic balloon counterpulsation
Mechanical ventilation
Temporary cardiac pacing
Acute kidney injury
Major bleeding
Acute stroke
Medical treatment during hospitalization
Unfractionated heparin
Low-molecular-weight heparin
Aspirin
Clopidogrel
Cilostazol
Blockers
Calcium channel blockers
Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker
Diuretics
Long-acting nitrates
Statin
PCI
(n 1,889)
Medical Therapy
(n 455)
p Value
1,889 (100%)
132 (29.0%)
0.001
0.39
43 (2.3%)
883 (46.7%)
387 (20.5%)
576 (30.5%)
6 (4.5%)
63 (47.7%)
24 (18.2%)
39 (29.5%)
808 (42.8%)
242 (12.8%)
296 (15.7%)
543 (28.7%)
35 (26.5%)
15 (11.4%)
20 (15.2%)
62 (47.0%)
30 (1.6%)
6 (0.3%)
20 (1.1%)
21 (1.1%)
15 (0.8%)
36 (1.9%)
23 (1.2%)
33 (1.7%)
6 (0.3%)
5 (0.3%)
3 (0.2%)
14 (3.1%)
2 (0.4%)
10 (2.2%)
1 (0.2%)
12 (2.6%)
2 (0.4%)
14 (3.1%)
1 (0.2%)
5 (1.1%)
2 (0.4%)
4 (0.9%)
0.001
1,134 (60.0%)
656 (34.7%)
1,877 (99.4%)
1,862 (98.6%)
596 (31.6%)
1,491 (78.9%)
222 (11.8%)
1,600 (84.7%)
471 (24.9%)
1,315 (69.6%)
1,493 (79.0%)
0.04
0.66
0.05
0.10
0.001
0.03
0.004
0.01
0.05
0.63
0.03
258 (56.7%)
135 (29.7%)
431 (94.7%)
405 (89.0%)
27 (5.9%)
300 (65.9%)
97 (21.3%)
344 (75.6%)
187 (41.1%)
325 (71.4%)
277 (60.9%)
0.19
0.04
0.001
0.001
0.001
0.001
0.001
0.001
0.001
0.45
0.001
Table 3
Unadjusted and adjusted clinical outcomes between percutaneous coronary intervention and medical therapy groups
Variable
In-hospital
Death
At 30 days
Death
Death/myocardial infarction
At 6 mo
Death
Death/myocardial infarction
At 12 mo
Death
Death/myocardial infarction
PCI
(n 1,889)
Medical Therapy
(n 455)
32 (1.7%)
Unadjusted
Adjusted*
HR (95% CI)
p Value
HR (95% CI)
24 (5.3%)
0.31 (0.180.53)
0.001
0.39 (0.220.70)
0.002
40 (2.1%)
43 (2.3%)
37 (8.1%)
39 (8.6%)
0.26 (0.170.41)
0.27 (0.170.41)
0.001
0.001
0.29 (0.180.47)
0.30 (0.190.48)
0.001
0.001
50 (2.6%)
58 (3.1%)
43 (9.5%)
47 (10.3%)
0.27 (0.180.41)
0.29 (0.200.43)
0.001
0.001
0.29 (0.190.45)
0.31 (0.210.48)
0.001
0.001
58 (3.1%)
72 (3.8%)
46 (10.1%)
51 (11.2%)
0.29 (0.200.43)
0.33 (0.230.47)
0.001
0.001
0.31 (0.200.47)
0.36 (0.250.53)
0.001
0.001
p Value
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Figure 1. PCI versus medical therapy and rates of death and MI at 12 months before and after adjustment by stratification by the propensity score. *Test for
heterogeneity, p 0.885. CI confidence interval; PS propensity score.
ical treatment during hospitalization. Unadjusted in-hospital mortality was lower in the PCI group (1.7% vs
5.3%, p 0.001; Table 3). The rates of death or MI at 12
months were also lower in the PCI group (3.8% vs 11.2%,
p 0.001). After adjustment, PCI was still associated with
lower in-hospital mortality (hazard ratio 0.39, 95% confidence interval 0.22 to 0.70; p 0.002). The 12-month
death/MI rates remained significantly lower in the PCI
group (hazard ratio 0.48, 95% confidence interval 0.33 to
0.70; p 0.001; Table 3 and Figures 1 and 2). In each
quintile of propensity for PCI, the 12-month death/MI rates
were lower for patients who underwent PCI than for those
who did not, with a hazard ratio of 0.30 to 0.64 (test for
heterogeneity, p 0.885), indicating that patients with the
same likelihood of undergoing PCI were more likely to
benefit if they actually underwent PCI (Figure 1). Additional analysis revealed that the favorable outcomes associ-
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Figure 3. Subgroup analysis of 12-month death/MI. CI confidence interval; HR hazard ratio; TIMI Thrombolysis In Myocardial Infarction.
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