Around 10% of all deaths following percutaneous coronary intervention (PCI) are potentially preventable, the authors of a study published in PLOS ONE which used data on in-hospital deaths after PCI at 39 centres in the US state of Michigan, have suggested.
“Deaths in the hospital after PCI are rare and mostly occur in patients who arrive after a heart attack, especially if their cases involve shock,” said senior author Hitinder Gurm (University of Michigan Health, Ann Arbor, USA). “The vast majority of deaths after PCI are unpreventable and related to patients’ underlying conditions for which they are undergoing the procedure. This is a stark change from the 1990s when the majority of deaths were traceable to procedural complications.”
The research team analysed deaths after PCI occurring at 39 hospitals participating in BMC2, a Michigan-wide cardiovascular consortium of healthcare providers, between 2012 and 2014. These hospitals use procedural and outcome data to inform quality projects to improve care and patient outcomes.
Procedural complications contributed to 20% of the nearly 1,200 deaths reported during the study period, the investigators report in their PLOS ONE paper. Just over one quarter of the patients who died were considered low risk, meaning a PCI-related mortality risk score estimated they had a 95% or greater chance of survival.
Left ventricular failure was the most common cause of death, occurring in 52% of cases, and the circumstance of death was most commonly related to prior acute cardiovascular condition (61% of cases). Procedural complications were considered contributing to mortality in 235 (20%) cases.
Of the deaths that were considered preventable, 10.1% in total, angioplasty and stenting was deemed to be of low value and potentially avoidable nearly one third of the time.
Researchers say the data suggest there is a need to focus on optimising appropriateness of PCI to ensure providers are limiting rare, preventable deaths from this common procedure.
“Our data may help inform how cath labs conduct morbidity and mortality conferences, a common quality improvement practice at many hospitals, by focusing on patients with low predicted risk of mortality who subsequently experienced an adverse event,” said first author Francesco Moroni (University of Virginia, Charlottesville, USA). “Such a focus may be an effective method of identifying on periprocedural practices, as opposed to patient-related factors, that may have played a role in a patient’s adverse outcome.”
