Abstract 15083: Precise Etiology of Death within 30 days of Percutaneous Coronary Intervention in an era of Mandatory Outcome Reporting

Abstract

Objectives: To ascertain the precise causes of death and the prevalence of percutaneous coronary intervention (PCI) related mortality within 30 days of PCI.

Background: Public reporting of 30-day post PCI mortality without clearly identifying the cause may have significant impact on patient management and willingness of operators to consider high risk cases. Previous reports on post PCI mortality have been limited by utilizing death certificates to identify cause of death.

Methods: All patients who died within 30 days of a PCI from Jan 2009 to April 2011 were included. Precise causes of mortality were identified through detailed chart review in accordance with the American Research Consortium consensus guidelines.

Results: A total of 4078 consecutive patients underwent elective or emergent PCI at our tertiary care center during this interval. Of these, 81 (2.0%) deaths occurred within 30 days of PCI of which precise etiology could be identified in 76 cases with cardiac (55%) and non-cardiac (45%) causes contributing nearly equally. Infection (17%) and neurological dysfunction (16%) were the major non-cardiac cause of death followed by pulmonary (5%), gastrointestinal (4%) and hemato-oncological causes (3%) (Figure 1). Death was attributed as a complication of the procedure in only 38% of the patients with probable stent thrombosis as the major etiology in 20 cases (69%). Cases with non-PCI related mortality were more likely to present with cardiogenic shock (32% versus 7%; p<0.01) and cardiac arrest (40% versus 3%; p<0.01).

Conclusions: Only a third of 30-day deaths are attributed to PCI related complications. Cardiogenic shock and cardiac arrest were the 2 presentations with the highest likelihood of non-PCI related mortality. Appropriate patient selection and better tools are needed to determine the precise cause of post PCI death if public reporting is to become a national standard.