Abstract 15787: Are Most Deaths After Percutaneous Coronary Intervention (PCI) Preventable? A Root-Cause Analysis
Background: Prior studies suggest that most deaths in patients undergoing percutaneous coronary intervention (PCI) are related to procedural complications. Mortality associated with PCI has steadily declined over the past decade but the cause and circumstance of death among patients undergoing contemporary PCI remains unknown.
Methods and results: We evaluated all patients undergoing PCI at the University of Michigan from 2001 to 2009. There were 75 deaths among a total of 5,141 patients undergoing PCI during this time period. Using a standardized data collection form, three cardiologists (two interventional, one non-invasive) assessed cause, circumstance and preventability of death. Left ventricular failure was the most common cause of death (37.3%, n=25), followed by neurologic compromise (16.4%, n=11) and arrhythmia (16.4%, n=11). Circumstance of death was mostly acute cardiac (61.5%, n=40), with procedural complication composing a small fraction (9.2%, n=6) of total deaths (Figure 1). Reviewers determined 92% of deaths to be mostly or entirely unpreventable (Figure 2).
Conclusions: Procedural complications are responsible for a small fraction of deaths among patients undergoing contemporary PCI. Measures to further enhance procedural safety are unlikely to translate into meaningful reductions in PCI mortality.
- © 2011 by American Heart Association, Inc.