In-Hospital Death Among Patients Undergoing Percutaneous Coronary Intervention: A Root-Cause Analysis.

Background: Mortality related to percutaneous coronary intervention (PCI) has gradually declined during the last decade. However, the causes and circumstances of death remain largely undescribed in contemporary practice.
Methods: We retrospectively evaluated all patients undergoing PCI at our institution from July 2013 to March 2021. Three cardiologists independently determined the causes and circumstances of death, and evaluated the preventability of death using validated methods.
Results: During study period, 4334 patients underwent 5506 PCIs, of whom 166 patients suffered in-hospital death (3.0%). Ninety-three percent of deceased patients initially presented with acute coronary syndrome, and 45% with cardiogenic shock. Left ventricular failure was the most common cause of death (39.7%), followed by neurologic compromise after cardiac arrest (16.8%) and infections (13.8%). The circumstance of death was most commonly acute cardiac (51.8%), followed by non-cardiac (19.2%) and non-procedural complications (17.4%). Death was attributed to a procedural complication in only 12% of cases. Reviewers determined that 90% of cases as being unpreventable or slightly preventable. Inter-reviewer agreement was substantial (the three reviewers agreed in >80% of cases for cause and preventability of death).
Conclusion: Mortality after PCI is uncommon, largely unpreventable, and most often related to pre-existing, acute cardiovascular conditions. Procedural complications account for a minority of cases of death, and future effort should focus on the treatment of acute cardiovascular conditions, in particular cardiogenic shock, to decrease acute mortality after PCI.
Competing Interests: Declaration of competing interest Lorenzo Azzalini reports a relationship with Teleflex that includes: consulting or advisory. Lorenzo Azzalini reports a relationship with AbioMed Inc. that includes: consulting or advisory. Lorenzo Azzalini reports a relationship with Asahi Intecc USA Incorporation that includes: consulting or advisory. Lorenzo Azzalini reports a relationship with Philips Healthcare US that includes: consulting or advisory. Lorenzo Azzalini reports a relationship with Abbott Vascular that includes: consulting or advisory. Lorenzo Azzalini reports a relationship with Cardiovascular Systems Inc. that includes: consulting or advisory. Hitinder S Gurm reports a relationship with Blue Cross Blue Shield of Michigan that includes: funding grants. Hitinder S Gurm reports a relationship with Michigan Translational Research and Commercialization for Life Sciences Innovation Hub that includes: funding grants. Hitinder S Gurm reports a relationship with Amplitude Vascular Systems that includes: consulting or advisory and equity or stocks. Hitinder S Gurm reports a relationship with Jiaxing Bossh Medical Technology Partnership that includes: equity or stocks. Hitinder S Gurm reports a relationship with Osprey Medical Inc. that includes: consulting or advisory. Hitinder S Gurm reports a relationship with Contego Medical that includes: consulting or advisory. Antonio Abbate reports a relationship with Astra Zeneca that includes: consulting or advisory. Antonio Abbate reports a relationship with Effetti Srl that includes: consulting or advisory. Antonio Abbate reports a relationship with Implicit Bioscience Inc. that includes: consulting or advisory. Antonio Abbate reports a relationship with Kiniksa Pharmaceuticals Ltd. that includes: consulting or advisory. Antonio Abbate reports a relationship with Janssen Pharmaceuticals Inc. that includes: consulting or advisory. Antonio Abbate reports a relationship with Merck & Co Inc. that includes: consulting or advisory. Antonio Abbate reports a relationship with Novartis that includes: consulting or advisory. Antonio Abbate reports a relationship with Novo Nordisk Inc. that includes: consulting or advisory. Antonio Abbate reports a relationship with Olatec that includes: consulting or advisory. Antonio Abbate reports a relationship with Serpin Pharma that includes: consulting or advisory.
(Copyright © 2022. Published by Elsevier Inc.)