Circumstances and mode of in-hospital death following 9,914 consecutive patients undergoing percutaneous coronary interventions in the northwest of England.
OBJECTIVE
To better describe the epidemiological causes of in-hospital death after percutaneous coronary intervention (PCI) in the present stent era.


METHODS
Systematic review of all in-hospital deaths following PCI in North West England from 2001 to 2003. Sixty-two in-hospital deaths (0.6%) were identified from 9,914 consecutive PCIs performed during the study period. The medical records of 4 patients were missing, leaving 58 patients to be reviewed with a standard data extraction tool to determine a circumstance and a mode of death. Medical records were reviewed at each center and cases were discussed at regional consensus meetings. All the collected data were validated by random cross-checking of data by exchange site visits. Multivariate logistic regression was used to identify risk factors for deaths related to procedural complications.


RESULTS
Low output failure was the most common mode of death, occurring in 42 patients (72.4%). The circumstance of death was a procedural complication in 35 patients (60.3%), and preexisting acute cardiac disease in 23 patients (39.7%). Significant predictors of death from procedural complications were treatment of left main stem (odds ratio [OR] 13.8; p < 0.001) or graft lesions (OR 5.6; p < 0.001), and female sex (OR 3.0; p = 0.002).


CONCLUSIONS
Procedural complications account for over half of all post-PCI deaths. We have identified several risk factors that may help reduce the number of deaths related to procedural complications.
Rathore
Sudhir
S
Cardiology Department, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, United Kingdom. sudhir.rathore@ctc.nhs.uk
Grayson
Antony D
AD
Sastry
Sanjay
S
Gray
Timothy P
TP
Beynon
Rhys
R
Jackson
Mark
M
Perry
Raphael A
RA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012307:Risk Factors