Less than half of deaths after angioplasty result of procedure, study shows

May 7, 2013, Cleveland Clinic

Only 42 percent of the deaths occurring within 30 days of percutaneous coronary interventions (PCI) were attributable to complications from the procedure, according to a Cleveland Clinic study published online in the Journal of the American College of Cardiology. The research suggests alternative outcome reporting mechanisms for 30-day mortality for PCI should be considered before mandatory reporting regulations are put into place.

PCI is a non-surgical procedure in which and/or stents are used to open blocked or narrowed , which are typically accessed via a placed in an artery in the groin area.

According to the researchers, public reporting of outcomes after PCI, and in particular 30-day mortality, is likely to be mandated by the federal government in the future and is already required in several states. The outcomes reporting would help patients make better informed decisions about their and could form the basis for determining reimbursement amounts from and . Additionally, the data would likely impact physician and hospital reputation, according to the study.

The researchers, led by Mehdi H. Shishehbor, D.O., M.P.H., Ph.D., Director of Endovascular Services in the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic, caution, however, that mandatory reporting also leads to risk avoidance, or physicians turning down the most risky patients – often those who would most benefit from a procedure – out of fear that the patient may die. Prior research has already shown that risk avoidance can occur when outcomes reporting is made mandatory.

The mortality rate for PCI is typically ascertained from death certificates and all cardiac deaths are reported in the 30-day mortality rate. In their study, Dr. Shishehbor and his colleagues examined the records of the 4,078 PCI procedures performed at a single tertiary care center between January 2009 and April 2011. There were 81 deaths occurring within 30 days of the procedure, and of these, 58 percent were cardiac deaths. However, when the researchers conducted a detailed chart review using established and accepted guidelines, they found that only 42 percent of the 30-day deaths were attributable to PCI-related complications, and they measured this in the most conservative manner, according to Dr. Shishehbor. Further, they found that death certificates were only 58 percent accurate for classifying cardiac versus non-cardiac death.

"Outcomes reporting is a vital component of our shift toward accountable care and will be extremely valuable to patients and physicians," said Dr. Shishehbor. "But we must ensure that we are reporting the right outcomes. If we attribute mortality incorrectly to PCI complications, this may lead to risk avoidance, meaning the sickest patients who would benefit the most from interventions – those presenting with heart attack and cardiac arrest – may not get the care they need."

The researchers suggest that outcomes reporting for PCI should be classified into PCI- and non-PCI-related deaths to best reflect quality and operator performance while holding hospitals and physicians accountable for the care they provide.

"These results highlight the limitations of 30-day reporting when death certificates are used and emphasize the need for identifying PCI-related deaths rather than cardiac deaths alone," the researchers write. They say it is "important to classify causes of death into categories which truly reflect a physician and an institution's competence and act as an indicator of performance."

Explore further: Rates of procedures such as angioplasty lower in states with public reporting of outcomes

Related Stories

Rates of procedures such as angioplasty lower in states with public reporting of outcomes

October 9, 2012
In an analysis that included nearly 100,000 Medicare patients who had experienced a heart attack, the use of a percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open ...

Major bleeding following PCI associated with increased risk of death

March 12, 2013
In a study that included 3.3 million percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) procedures, major bleeding after PCI was associated ...

Angioplasty at hospitals without on-site cardiac surgery safe, effective

March 11, 2013
Non-emergency angioplasty performed at hospitals without on-site cardiac surgery capability is no less safe and effective than angioplasty performed at hospitals with cardiac surgery services, according to research presented ...

Increases in mean platelet volume after PCI tied to death

January 25, 2013
(HealthDay)—For patients who undergo percutaneous coronary intervention (PCI), mortality is associated with increases in mean platelet volume (MPV) over time following the procedure, according to a study published in the ...

Elevated protein levels in cardiac muscles could predict mortality following angioplasty

May 13, 2011
New research shows that elevated levels of cardiac troponin T (cTnT) or I (cTnI) in patients who had angioplasty indicate a higher risk of all-cause mortality and long-term adverse events such as heart attack. Routine monitoring ...

Long-term outcome similar with thrombus aspiration and stents in PCI

May 2, 2012
New research confirms thrombus aspiration (TA) during percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) provides long-term outcomes similar to conventional ...

Recommended for you

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

Place of residence linked to heart failure risk

January 9, 2018
Location. Location. Location.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.