Percutaneous coronary intervention (PCI)-related mortality has received limited study. We examined patients who died during or immediately after PCI among 22,503 patients who underwent PCI at 2 centers in the PROGRESS COMPLICATIONS registry (NCT05100940). Of the 22,503 patients, 115 (0.5%) died before discharge, of whom 15 (13.0%) died during PCI, 10 (8.7%) during the first 24 hours and 90 (78.3%) >24 hours post-PCI. Patients who died had high burden of comorbidities. Common presentations were NSTEMI (45.6%) and STEMI (38.6%). Femoral access was used in 86.1%. The most common target vessels were the left anterior descending (37.7%) and the right coronary artery (27.2%). Target lesions were complex: 35% were bifurcations, 60% had moderate or severe calcification, and 35% had moderate or severe tortuosity. Technical success was 78.3% and left ventricular assist devices (LVAD) were used in 42.1%. Of those LVADs, 52.2% were emergent and 39.1% were prophylactic. Median time to death after PCI was 6 days. Major complications included cardiac arrest (31.3%), bleeding (28.7%), stroke (27.0%), cardiogenic shock (26.1%), perforation (13.9%), coronary dissection (11.3%), and myocardial infarction (8.7%). Cardiogenic shock accounted for 80.9% of deaths, primarily secondary to acute myocardial infarction (58.3%), cardiac arrest (6.1%) and coronary perforation (3.5%). Noncardiac causes accounted for 19.1% of deaths and included infection (6.1%), aortic dissection (3.5%), acute respiratory failure (3.5%) and stroke (2.6%). Patients who died from cardiogenic shock had high rates of LVAD use (47.8%), 14.3% of whom required escalation. Periprocedural death after PCI occurred in 0.5% of all cases, was more common in highly complex lesions and was associated with presentation acuity. Cardiogenic shock was the most common cause of death.
Estimating the risk of periprocedural mortality after percutaneous coronary intervention (PCI) is crucial for risk stratification and quality assessment. Despite the increasing complexity and comorbidities of patients presenting for catheterization and intervention, outcomes, including mortality, have been improving. Yulanka et al. analyzed 706,263 PCIs and found that acute coronary syndrome (ACS) presentation, hemodynamic instability and level of consciousness were highly correlated with periprocedural mortality. A study of 2,196,661 patients undergoing PCI showed higher in-hospital mortality in patients with procedural complications (19.7% vs 1.3%). We examined the clinical and procedural characteristics and causes of death after PCI in a large multicenter registry.
We examined the clinical and angiographic records of patients who underwent PCI between 2014 and 2024 at 2 US centers from the PROGRESS-COMPLICATIONS registry (NCT05100940). Technical success was defined as successful revascularization with achievement of <30% residual diameter stenosis within the treated segment and restoration of TIMI grade 3 antegrade flow. Categorical variables were expressed as percentages and compared using the Pearson’s chi-square test. Continuous variables were presented as mean ± standard deviation or median (interquartile range) unless otherwise specified and were compared using the independent-samples t-test for normally distributed variables and the Mann–Whitney U test for nonparametric variables, as appropriate. All statistical analyses were performed with R Statistical Software, version 4.4.0 (R Foundation for Statistical Computing, Vienna, Austria). A p-value of <0.05 was considered statistically significant.
Of 22,503 patients who underwent PCI during the study period, 115 (0.5%) died during the index hospitalization. Death occurred during PCI in 15 (13.0%), within 24 hours in 10 (8.7%), and after 24 hours in 90 (78.3%) patients. Mean patient age was 72 years ± 9.67, body mass index (BMI) was 31.5 kg/m 2, and 62.6% were men. Patients who died had high prevalence of comorbidities and most commonly presented with non-ST-segment elevation MI (NSTEMI, 45.6%) and ST-segment elevation MI (STEMI, 38.6%) ( Table 1 ).
Table 1
Demographic characteristics of the patients who died during or after PCI
| Variables |
Overall
(n = 115) |
|---|---|
| Age (y) | 72.35 ± 9.67 |
| Gender, male | 62.6% (72) |
| BMI | 31.49 ± 8.03 |
| Hypertension | 91.2% (104) |
| Diabetes mellitus | 53.5% (61) |
| Dyslipidemia | 88.7% (102) |
| Smoking, current | 11.3% (13) |
| Left ventricular ejection fraction (%) | 40.02 ± 13.15 |
| Family history of CAD | 12.2% (14) |
| Heart failure | 61.7% (71) |
| Prior CABG | 14.8% (17) |
| Prior PCI | 37.4% (43) |
| Prior MI | 41.1% (46) |
| Cerebrovascular disease | 12.3% (14) |
| Chronic kidney disease | 66.1% (76) |
| Peripheral arterial disease | 27.8% (32) |
| CAD presentation | |
| Stable angina | 13.2% (15) |
| Unstable angina | 0.9% (1) |
| NSTEMI | 45.6% (52) |
| STEMI | 38.6% (44) |
| No symptoms | 1.8% (2) |
| Baseline creatinine (mg/dl) | 1.55 (1.16, 2.23) |
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