ABC | Volume 111, Nº4, Octuber 2018

Original Article Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010 Christina Grüne de Souza e Silva, 1 Carlos Henrique Klein, 2 Paulo Henrique Godoy, 3 Lucia Helena Alvares Salis, 1 Nelson Albuquerque de Souza e Silva 1 Instituto do Coração Edson Saad, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, 1 Rio de Janeiro, RJ – Brazil Escola Nacional de Saúde Pública Sergio Arouca – Fundação Oswaldo Cruz, 2 Rio de Janeiro, RJ – Brazil Universidade Federal do Estado do Rio de Janeiro, 3 Rio de Janeiro, RJ – Brazil Mailing Address: Christina Grüne de Souza e Silva • Rua Professor Rodolpho Paulo Rocco, 225 - 8º andar - Cidade Universitária. Postal Code 21941-913, Ilha do Fundão, RJ - Brazil E-mail: christina.g.dss@gmail.com Manuscript received December 01, 2017, revised Manuscript May 01, 2018, accepted May 23, 2018 DOI: 10.5935/abc.20180184 Abstract Background: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI’s effectiveness should be conducted in a population of real‑world patients. Objectives: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). Methods: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system ( SUS ) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. Results: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8‑94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8‑60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty. (Arq Bras Cardiol. 2018; 111(4):553-561) Keywords: Myocardial Revascularization; Coronary Artery Disease; Percutaneous Coronary Intervention; Mortality. Introduction Ischemic heart disease (IHD) is the most frequent cause of death in adults 1 and, although its age-standardized mortality rate has decreased over the last decades, 2 IHD is still the cause of about 20% of all deaths worldwide. 2,3 The most frequent invasive therapy for IHD is percutaneous coronary intervention (PCI). 4 Since it was first performed, 5-7 this procedure has been increasingly utilized, more expensive and possibly overused, 8,9 although the majority of the studies conducted have evidenced just a few scenarios where PCI can be beneficial in IHD. 10,11 Moreover, the information that guides physicians’ decisions regarding its indication is mostly based on randomized controlled clinical trials (RCT), which usually enroll younger patients with fewer comorbid conditions than patients in the real-world, and exclude many treatment‑related issues faced in clinical practice. 12,13 Therefore, extrapolating PCI’s effectiveness observed in RCTs to the real world‑population may not be entirely appropriate. This study aims at providing information about PCI’s effectiveness in a real-world population by assessing short-, medium- and long-term survival rates of IHD patients treated with one single PCI, from 1999 to 2010, and paid by the Brazilian public healthcare system ( Sistema Único de Saúde – SUS ) in the state of Rio de Janeiro (RJ). 553