Scientific Online Resource System

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


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.


percutaneous coronary interventions, mortality, risk profile

Full Text


Ammann, P. et al. Procedural complications following diagnostic coronary angiography are related to the operator's experience and the catheter size.- Catheter Cardiovasc Interv., 2003, 59, 13-18

Anderson, H. et al. A contemporary overview of percutaneous coronary interventions. The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). - J Am Coll Cardiol, 2002, 39(7), 1096- 1103

Baim, D. S. Grossman`s Cardiac Catheterization, Angiography and Intervention. Lippincott Williams and Wilkins, 2006, 38

Chandrasekar, B. et al. Complications of cardiac catheterization in the current era: a single-center experience. - Catheter Cardiovasc Interv., 52(3), 2001, 289-95

Cram, P. et al, Percutaneous coronary intervention outcomes in US hospitals with varying structural characteristics: Analysis of the NCDR. - Am Heart J, 2012, 163(2) , 222-229

de Bono, D. et al. Complications of diagnostic cardiac catheterization: results from 34,041 patients in the United Kingdom confidential enquiry into cardiac catheter complications. The Joint Audit Committee of the British Cardiac Society and Royal College of Physicians of London.- Br Heart J., 70(3), 1993, 297-300

Baim, D. et al. Final results of the Balloon vs Optimal Atherectomy Trial (BOAT). - Circulation, 1998, 97, 322- 331

Detre, K. et al. Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981. The National Heart, Lung, and Blood Institute Registry. - N Engl J Med, 1988, 318, 265-270

Fischman, D. et al. A randomized comparison of coronary- stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. - N Engl J Med, 1994, 331, 496-501

Levine, G. N. ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions Circulation.- 2011, 124, 574-651

Perk, J. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J doi:10.1093/eurheartj/ehs092

Serruys, P. et al. Randomized comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II). - Lancet, 1998, 352, 673-681

Sianos, G. et al. The SYNTAX score: an angiographic tool grading the complexity of CAD.- Euro Interv, 1, 2005, 219-227

Tavakol, M. et al., Risks and Complications of Coronary Angiography: A Comprehensive Review. - Global Journal of Health Science, 2012, 4(1), 65-93

West, R. et al. Complications of diagnostic cardiac catheterization: results from a confidential inquiry into cardiac catheter complications. - Heart, 2006, 92(6), 810- 814

Williams, D. et al. Outcomes of 6906 patients undergoing percutaneous coronary intervention in the era of drug-eluting stents: Report of the DEScover Registry. - Circulation 2006, 114, 2154-2162

Williams, D. et al. Percutaneous coronary intervention in the current era compared with 1985-1986: The National Heart, Lung, and Blood Institute Registries. - Circulation, 2000, 102, 2945-2951

Zhang, Z. et al Relationship Between Hospital Coronary Angioplasty Volume and In-Hospital Mortality: A Report from the American College of Cardiology-National Cardiovascular Data Registry. - AHA congress 2005



Font Size