In-lab cardiac mortality during PCI was linked to older age, ischemic time ≥360 min, low BP, anterior MI, diabetes, dyslipidemia, smoking, multivessel disease, and TIMI 0 flow.
What clinical and procedural factors are associated with in-lab cardiac mortality in patients undergoing emergency or early invasive PCI for ACS?
In-lab cardiac mortality during emergency PCI for ACS is strongly associated with severe baseline disease, compromised hemodynamics at presentation, longer ischemic times, and procedural complications.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction The in-lab cardiac mortality (ILCM), which accounts for less than 4% of these events, is not systematically explored till date. Purpose Therefore, the aim of this study was to comprehensively evaluate and analyze the deaths due to ILCM in a low-middle income setting. Methods This descriptive cross-sectional study included adult patients (≥18 years) with acute coronary syndrome (ACS) undergoing emergency or early invasive percutaneous coronary intervention (PCI), who had ILCM. Data for the patients in in-hospital cardiac mortality (IHCM) and survival group for comparison was obtained from hospital records against the same duration (NCDR CathPCI Registry). Data on demographic, clinical, and angiographic characteristics, as well as in-hospital complications, were collected. Results A total of 6,434 procedures were performed, 319 developed in-lab cardiac arrest and 166 died on table. The patients with ILCM were predominantly male (79.5%), with a mean age of 60.7 ± 9.3 years. The most common patient related complication was slow flow/no-reflow occurred in 68.1% of patients followed by arrhythmias occurred in 46.4%, and high risk anatomy in 8.4%. The most common procedure related complication was observed to be thrombus shifted to non-IRA observed in 9.6%, followed by definite ST in 6%, dissection in 6%, while, unable to wire, stent, or balloon (with TIMI 0 flow) was collectively observed in 7.8% (Figure 1). On multivariable analysis for ILCM, compared to survived patients, advanced age, total ischemic time ≥ 360 minutes, systolic blood pressure ≤ 90 mmHg, anterior wall MI, presence of diabetes mellitus, dyslipidemia, smoking status, multivessel disease, and TIMI (pre-procedural) 0 flow were found to be significantly associates with increased risk of ILCM (Table 1). Conclusion(s) Most of the patients who developed ILCA resulting in on-table mortality had severe disease with multi-vessel involvement, compromised vitals at presentation, and longer total ischemic and higher burden of co-morbid conditions and atherosclerotic disease. In addition of the patients related complications such as slow flow/no-reflow, arrhythmias, procedure related factors such as thrombus shifted to non-IRA, definite ST, dissection, and procedure failure were also common in these patients.Figure 1 Table 1
Farooq et al. (Sat,) reported a other. In-lab cardiac mortality during PCI was linked to older age, ischemic time ≥360 min, low BP, anterior MI, diabetes, dyslipidemia, smoking, multivessel disease, and TIMI 0 flow.