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Cause of Death Within 30 Days of Percutaneous Coronary Intervention in an Era of Mandatory Outcome Reporting.
J Am Coll Cardiol. 2013 May 8;
Authors: Aggarwal B, Ellis SG, Lincoff AM, Kapadia SR, Cacchione J, Raymond RE, Cho L, Bajzer C, Nair R, Franco I, Simpfendorfer C, Tuzcu EM, Whitlow PL, Shishehbor MH
Abstract
OBJECTIVES: To ascertain causes of death and the incidence of percutaneous coronary intervention (PCI) related mortality within 30 days. BACKGROUND: Public reporting of 30-day mortality after PCI without clearly identifying the cause may result in operator risk avoidance and impact hospital reputation and reimbursements. Death certificates, utilized by previous reports, have poor correlation with actual cause of death and may be inadequate for public reporting. METHODS: All patients who died within 30 days of a PCI from January 2009 to April 2011 at a tertiary care center were included. Causes of death were identified through detailed chart review using Academic Research Consortium consensus guidelines and compared to reported death certificates. The causes of death were divided into cardiac and non-cardiac and PCI and non PCI-related categories. RESULTS: Of the 4078 PCIs, 81 deaths (2%) occurred within 30 days. Of these, 58% died of cardiac and 42% of non-cardiac causes. However, only 42% of 30-day deaths were attributed to PCI-related complications. Compared to PCI-related, patients with non PCI-related death presented with a higher incidence of cardiogenic shock (15/47 (32%) versus 2/34 (6%); p < 0.01) and cardiac arrest (19/47 (40%) versus 1/34 (3%); p < 0.01). Death certificates had only 58% accuracy (95% CI, 45%-72%) for classifying patients as experiencing cardiac versus non-cardiac death. CONCLUSIONS: Less than half of 30-day deaths are attributed to a PCI-related complication. Death certificates are inaccurate and do not report PCI-related deaths, which may represent a better marker of PCI quality.
PMID: 23665371 [PubMed - as supplied by publisher]