In-Hospital Death Among Patients Undergoing Percutaneous Coronary Intervention: A Root-Cause Analysis

Mortality related to percutaneous coronary intervention (PCI) has gradually declined during the last decade. However, the causes and circumstances of death remain largely undescribed in contemporary practice.

We retrospectively evaluated all patients undergoing PCI at our institution from July 2013 to March 2021. Three cardiologists independently determined the causes and circumstances of death, and evaluated the preventability of death using validated methods.

During study period, 4334 patients underwent 5506 PCIs, of whom 166 patients suffered in-hospital death (3.0%). Ninety-three percent of deceased patients initially presented with acute coronary syndrome, and 45% with cardiogenic shock. Left ventricular failure was the most common cause of death (39.7%), followed by neurologic compromise after cardiac arrest (16.8%) and infections (13.8%). The circumstance of death was most commonly acute cardiac (51.8%), followed by non-cardiac (19.2%) and non-procedural complications (17.4%). Death was attributed to a procedural complication in only 12% of cases. Reviewers determined that 90% of cases as being unpreventable or slightly preventable. Inter-reviewer agreement was substantial (the three reviewers agreed in >80% of cases for cause and preventability of death).

Mortality after PCI is uncommon, largely unpreventable, and most often related to pre-existing, acute cardiovascular conditions. Procedural complications account for a minority of cases of death, and future effort should focus on the treatment of acute cardiovascular conditions, in particular cardiogenic shock, to decrease acute mortality after PCI.