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Heart - Lung (Varna)

Lethal outcome associated with percutaneous coronary interventions in patients with coronary artery disease - a complication or natural progression of the disease?

Svetoslav Georgiev, P. Penchev, P. Aleksovski

Abstract

Objective: There is a rapid progress of interventional cardiology in Bulgaria in the last years but there are no exact data on the complications of the interventional procedures. Our aim was to study the rate and causes of in-hospital mortality in MHAT Sveta Marina, Varna, associated with elected invasive strategy in patients with coronary artery disease (CAD).

Material and methods: We investigated retrospectively 2 036 consecutive patients with CAD, hospitalized in the Clinic of Interventional Cardiology in MHAT Sveta Marina, Varna, from January 1, 2011 to December 31, 2011. Approximately half of the patients (1 019) had diagnostic interventions and the rest of them had also therapeutic interventions. We studied all the cases with lethal outcome and analyzed the causes of this outcome. The data were compared with the results from big trials and registries (ACC-NCDR Registry) for mortality, associated with coronary interventions.

Results: More than half of the patients had planned hospitalization (1 218; 60%) and the rest were hospitalized with acute coronary syndrome (ACS). We had in-hospital lethal outcome in 13 patients (0.6%), 6 male and 7 female with mean age 72±8 (56-82). Only 2 patients (15%) with ACS without ST-elevation died and they had only diagnostic intervention, and the rest patients with lethal outcome (11; 85%) had STEMI at admission and therapeutic interventions. The total number of patients with STEMI and primary PCI for the period was 171 and the in-hospital mortality among them was 6.4% (11 pts.). There were no lethal cases among patients with planned interventions. The analysis of the death cases shows that all these patients had bad risk profile with a lot of concomitant diseases. Most of them had severe coronary disease (SYNTAX Score = 34±17); they were hospitalized late and had different types of complications.

In 31% (4/13) of the patients with lethal outcome death occurred during PCI or just after the coronary intervention, but the majority of the patients (6/13; 46%) died more than 24 hours after the procedure, having a good angiographic result. The most frequent mechanism of death was electro-mechanical dissociation.

Conclusions: Death is still the most severe possible outcome of PCI. In-hospital mortality in patients with CAD and coronary interventions in MHAT Sveta Marina Varna is similar to the results from big trials. The lethal outcome in these cases is primarily a result of the normal progression of CAD or the concomitant diseases and less a result of the chosen invasive strategy and applied interventional procedures.


Keywords

percutaneous coronary interventions, mortality, risk profile

Full Text


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DOI: http://dx.doi.org/10.14748/hl.v18i1-2.3344

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