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Failure to Rescue After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry

传统PCI 医学 并发症 经皮冠状动脉介入治疗 心源性休克 急诊医学 内科学 回顾性队列研究 血管成形术 逻辑回归 心脏病学 外科 心肌梗塞
作者
Jacob A. Doll,Akash Kataruka,Pratik Manandhar,Daniel Wojdyla,Robert W. Yeh,Tracy Y Wang,Ravi S. Hira
出处
期刊:Circulation-cardiovascular Interventions [Ovid Technologies (Wolters Kluwer)]
标识
DOI:10.1161/circinterventions.123.013670
摘要

BACKGROUND: Failure to rescue (FTR) describes in-hospital mortality following a procedural complication and has been adopted as a quality metric in multiple specialties. However, FTR has not been studied for percutaneous coronary intervention (PCI) complications. METHODS: This is a retrospective study of patients undergoing PCI from the American College of Cardiology National Cardiovascular Data Registry’s CathPCI Registry between April 1, 2018, and June 30, 2021. PCI complications evaluated were significant coronary dissection, coronary artery perforation, vascular complication, significant bleeding within 48 hours, new cardiogenic shock, and tamponade. Secular trends for FTR were evaluated with descriptive analysis, and hospital-level variation and clinical predictors were analyzed with logistic regression. RESULTS: Among 2 196 661 patients undergoing PCI at 1483 hospitals, 3.5% had at least 1 PCI complication. In-hospital mortality occurred more frequently following a complication compared with cases without a complication (19.7% versus 1.3%). FTR increased during the study period from 17.1% to 20.1% ( P <0.001). The median odds ratio for FTR was 1.48 (95% CI, 1.44–1.53) indicating significant hospital-level variation. Spearman rank correlation demonstrated the modest correlation between FTR and in-hospital mortality, 0.525 ( P <0.001). CONCLUSIONS: Major procedural complications during PCI are infrequent, but FTR occurs in roughly 1 in 5 patients following a PCI procedural complication with significant hospital-level variation. Improved understanding of practices associated with low FTR could meaningfully improve patient outcomes following a PCI complication.
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