- 作者：Bhuvnesh Aggarwal ; Stephen G. Ellis ; A. Michael Lincoff ; Samir R. Kapadia ; Joseph Cacchione ; Russell E. Raymond ; Leslie Cho ; Christopher Bajzer ; Ravi Nair ; Irving Franco ; Conrad Simpfendorfer ; E. Murat Tuzcu ; Patrick L. Whitlow ; Mehdi H. Shishehbor
- 关键词：cause of death ; coronary intervention ; mortality ; outcomes ; public reporting ; risk avoidance
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：30 July, 2013
- 年：2013
- 卷：62
- 期：5
- 页码：409-415
- 全文大小：545 K
Objectives
This study sought 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 affect 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 with reported death certificates. The causes of death were divided into cardiac and noncardiac and PCI and non-PCI-related categories.
Results
Of the 4,078 PCI, 81 deaths (2 % ) occurred within 30 days. Of these, 58 % died of cardiac and 42 % of noncardiac causes. However, only 42 % of 30-day deaths were attributed to PCI-related complications. Patients with non-PCI-related, compared with PCI-related, death presented with a higher incidence of cardiogenic shock (15 of 47 [32 % ] vs. 2 of 34 [6 % ]; p?< 0.01) and cardiac arrest (19 of 47 [40 % ] vs. 1 of 34 [3 % ]; p?< 0.01). Death certificates had only 58 % accuracy (95 % confidence interval: 45 % to 72 % ) for classifying patients as experiencing cardiac versus noncardiac death.
Conclusions
Less than one-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.