Cause of in-hospital death in 12,232 consecutive patients undergoing percutaneous transluminal coronary angioplasty. The Northern New England Cardiovascular Disease Study Group.
BACKGROUND
Some deaths after percutaneous coronary angioplasty (PTCA) occur in high-risk situations (eg, shock), whereas others are unexpected and related to procedural complications. To better describe the epidemiologic causes of death after PTCA, we undertook a systematic review of all in-hospital PTCA deaths in Northern New England from 1990 to 1993.


METHODS
The medical records of 121 patients who died during their acute hospitalization for PTCA were reviewed with a standardized data extraction tool to determine a mode of death (eg, low output failure, arrhythmia, respiratory failure) and a circumstance of death (eg, death attributable to a procedural complication, preexisting acute cardiac disease). Any death not classified as a procedural complication was reviewed by a committee and the circumstance of death assigned by a majority rule.


RESULTS
Low-output failure was the most common mode of death occurring in 80 (66.1%) of 121 patients. Other modes of death included ventricular arrhythmias (10.7%), stroke (4.1%), preexisting renal failure (4.1%), bleeding (2.5%), ventricular rupture (2.5%), respiratory failure (2.5%), pulmonary embolism (1.7%), and infection (1.7%). The circumstance of death was a procedural complication in 65 patients (53.7%) and a preexisting acute cardiac condition in 41 patients (33.9%). Women were more likely to die of a procedural complication than were men.


CONCLUSIONS
Procedural complications account for half of all post-PTCA deaths and are a particular problem for women. Other deaths are more directly related to patient acuity or noncardiac, comorbid conditions. Understanding why women face an increased risk of procedural complications may lead to improved outcomes for all patients.
Malenka
D J
DJ
Sections of Cardiology and Clinical Research, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. david.malenka@hitchcock.org
O'Rourke
D
D
Miller
M A
MA
Hearne
M J
MJ
Shubrooks
S
S
Kellett
M A
MA
Robb
J F
JF
O'Meara
J R
JR
VerLee
P
P
Bradley
W A
WA
Wennberg
D
D
Ryan
T
T
Vaitkus
P T
PT
Hettleman
B
B
Watkins
M W
MW
McGrath
P D
PD
O'Connor
G T
GT
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D002423:Cause of Death; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D012189:Retrospective Studies; D012737:Sex Factors