Division of Cardiology, Berne Cardiovascular Research Center and Heart and Vascular Center, School of Medicine, University of Virginia, Charlottesville, Virginia, United States of America.
Deparment of Medicine, Università Milano-Bicocca, Milan, Italy.
PLoS One. 2024 Mar 27;19(3):e0297596. doi: 10.1371/journal.pone.0297596. eCollection 2024.
Mortality is the most devastating complication of percutaneous coronary interventions (PCI). Identifying the most common causes and mechanisms of death after PCI in contemporary practice is an important step in further reducing periprocedural mortality.
To systematically analyze the cause and circumstances of in-hospital mortality in a large, multi-center, statewide cohort.
In-hospital deaths after PCI occurring at 39 hospitals included in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) between 2012 and 2014 were retrospectively reviewed using validated methods. A priori PCI-related mortality risk was estimated using the validated BMC2 model.
A total of 1,163 deaths after PCI were included in the study. Mean age was 71±13 years, and 507 (44%) were women. Left ventricular failure was the most common cause of death (52% of cases). 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. Death was rated as not preventable or slightly preventable in 1,045 (89.9%) cases. The majority of the deaths occurred in intermediate or high-risk patients, but 328 (28.2%) deaths occurred in low-risk patients (<5% predicted risk of mortality). PCI was considered rarely appropriate in 30% of preventable deaths.
In-hospital mortality after PCI is rare, and primarily related to pre-existing critical acute cardiovascular condition. However, approximately 10% of deaths were preventable. Further research is needed to characterize preventable deaths, in order to develop strategies to improve procedural safety.
死亡率是经皮冠状动脉介入治疗（PCI）最具破坏性的并发症。在当代实践中，确定 PCI 后死亡的最常见原因和机制是进一步降低围手术期死亡率的重要步骤。
系统分析大规模、多中心、全州范围内队列中 PCI 后住院期间死亡的原因和情况。
使用经过验证的方法回顾性分析了 2012 年至 2014 年期间密歇根蓝十字蓝盾心血管联合会（BMC2）的 39 家医院中发生的 PCI 后住院期间死亡的情况。使用经过验证的 BMC2 模型预先估计了与 PCI 相关的死亡风险。
本研究共纳入 1163 例 PCI 后死亡。平均年龄为 71±13 岁，507 例（44%）为女性。左心室衰竭是最常见的死亡原因（52%的病例）。死亡的情况最常见的与先前的急性心血管状况有关（61%的病例）。在 235 例（20%）病例中，程序并发症被认为是导致死亡的原因。在 1045 例（89.9%）病例中，死亡被评为无法预防或略可预防。大多数死亡发生在中危或高危患者中，但 328 例（28.2%）死亡发生在低危患者（<5%预测死亡率）中。在可预防的死亡中，有 30%的 PCI 被认为不太合适。
PCI 后住院期间死亡率较低，主要与先前存在的严重急性心血管状况有关。然而，约 10%的死亡是可以预防的。需要进一步研究可预防的死亡，以制定改善手术安全性的策略。
