Factors predictive for in-hospital mortality following percutaneous coronary intervention

Despite advances in procedures for percutaneous coronary intervention (PCI) and enhancement of materials and adjunctive therapy, postprocedural mortality remains a possible adverse outcome after PCI.

To assess factors independently associated with in-hospital mortality in patients referred for PCI.

Between January 2004 and December 2005, 4074 PCI were performed in our University Hospital, with 70 deaths registered either during the procedure or during the in-hospital stay. The 70 patients who died were age- and sex-matched with 70 controls in a case-control design study. Clinical and angiographic characteristics at hospital admission were collected from the patients' medical files.

The cumulative incidence rate for in-hospital mortality was 1.72%. Variables positively and significantly associated with in-hospital mortality were severe renal failure (55.7% in cases versus 12.9% in controls, p<0.0001), cardiac failure (26.1% versus 10.1%, p=0.01), ST-segment elevation myocardial infarction (STEMI) (70.6% versus 31.4%, p<0.0001), proximal coronary lesion (72.9% versus 40.0%, p<0.0001) and angiographically visible thrombus (14.3% versus 4.3%, p=0.04). Conversely, history of coronary heart disease, smoking and dyslipidemia were less frequent among cases. In multivariable analysis, the adjusted odds ratios (OR) for in-hospital death were 4.89 (95% confidence interval [CI] 1.96-12.2, p<0.001) in STEMI versus non-STEMI, 4.28 (95% CI 1.73-10.6, p<0.01) in those with a proximal coronary lesion, and 9.77 (95% CI 3.42-27.9, p<0.0001) in patients with severe renal failure.

STEMI, proximal coronary lesion, and renal failure at admission are identified as particular settings associated with a higher probability of in-hospital mortality after PCI.