Circumstances and mode of in-hospital death following 9,914 consecutive patients undergoing percutaneous coronary interventions in the northwest of England.

AIM: 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.