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Background  Whereas composite end points are often used in clinical trials of percutaneous coronary interventions ( PCI ), the impact of individual components on subsequent survival is incompletely defined. We evaluated the association of subsequent acute coronary syndromes ( ACS ) and unplanned coronary revascularization post‐ PCI  with long‐term survival.    Methods and Results  From 2009 to 2011, the Ki CS ‐ PCI  (Keio interhospital Cardiovascular Studies) consecutively enrolled patients undergoing  PCI  in 14 Japanese teaching hospitals. We identified patients who experienced  ACS  or unplanned coronary revascularization following their index  PCI  and compared subsequent survival during the 2‐year follow‐up period using propensity‐matched cohorts of patients who did and did not experience these events. Cox proportional hazard models were used to assess 2‐year all‐cause mortality. Because unstable angina is less severe than acute myocardial infarction, we also generated a separate propensity‐matched cohort for  UA  post‐ PCI . Among 3348  PCI  patients (mean age, 67.5±10.7 years; 79.7% male), 214 (6.4%) experienced a subsequent  ACS  (168 events [78.5%] were unstable angina), and 198 (5.9%) underwent unplanned revascularization. In the propensity‐matched cohorts, patients with a subsequent  ACS  admission had an increased risk of mortality as compared with those without (hazard ratio, 4.73; 95% confidence interval=1.35–16.6;  P =0.015), whereas those with an unplanned revascularization did not have significantly higher risk (hazard ratio, 2.97; 95% confidence interval=0.57–14.3;  P =0.19). Among unstable angina events, no association with mortality was observed (hazard ratio, 1.39; 95% confidence interval=0.48–4.00;  P =0.54).    Conclusions  In the Ki CS ‐ PCI  registry, the incidence of a subsequent  ACS  was associated with higher mortality, but this association was less apparent after unplanned coronary revascularization or unstable angina. The prognostic implications of different outcomes in a composite end point should be considered when interpreting the results of clinical trials in  PCI .

journal of the american heart association

Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long‐Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry