Failure to Rescue After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry

Area of Science:

• Cardiology
• Healthcare Quality Improvement
• Patient Safety

Background:

• Failure to rescue (FTR) is an established quality metric for in-hospital mortality after procedural complications.
• FTR has not been previously studied in the context of percutaneous coronary intervention (PCI).

Purpose of the Study:

• To investigate Failure to Rescue (FTR) rates following percutaneous coronary intervention (PCI) complications.
• To analyze trends, hospital-level variations, and predictors of FTR in PCI patients.

Main Methods:

• Retrospective analysis of 2,196,661 patients undergoing PCI from the CathPCI Registry (April 2018-June 2021).
• Evaluation of specific PCI complications including dissection, perforation, bleeding, shock, and tamponade.
• Logistic regression and descriptive analysis to assess FTR trends, hospital variation, and predictors.

Main Results:

• 3.5% of PCI patients experienced at least one complication.
• In-hospital mortality was significantly higher in patients with complications (19.7%) versus without (1.3%).
• FTR increased from 17.1% to 20.1% during the study period, with significant hospital variation (median OR 1.48).

Conclusions:

• Major PCI complications are infrequent, but FTR affects approximately 1 in 5 patients experiencing a complication.
• Significant hospital-level variation in FTR suggests opportunities for quality improvement.
• Understanding practices associated with lower FTR can enhance outcomes for patients with PCI complications.