Death Following Percutaneous Coronary Intervention: Data From the PROGRESS-COMPLICATIONS Registry.

Percutaneous coronary intervention (PCI)-related mortality has received limited study. We examined patients who died during or immediately after PCI among 22,503 patients who underwent PCI at 2 centers in the PROGRESS COMPLICATIONS registry (NCT05100940). Of the 22,503 patients, 115 (0.5%) died before discharge, of whom 15 (13.0%) died during PCI, 10 (8.7%) during the first 24 hours and 90 (78.3%) >24 hours post-PCI. Patients who died had high burden of comorbidities. Common presentations were NSTEMI (45.6%) and STEMI (38.6%). Femoral access was used in 86.1%. The most common target vessels were the left anterior descending (37.7%) and the right coronary artery (27.2%). Target lesions were complex: 35% were bifurcations, 60% had moderate or severe calcification, and 35% had moderate or severe tortuosity. Technical success was 78.3% and left ventricular assist devices (LVAD) were used in 42.1%. Of those LVADs, 52.2% were emergent and 39.1% were prophylactic. Median time to death after PCI was 6 days. Major complications included cardiac arrest (31.3%), bleeding (28.7%), stroke (27.0%), cardiogenic shock (26.1%), perforation (13.9%), coronary dissection (11.3%), and myocardial infarction (8.7%). Cardiogenic shock accounted for 80.9% of deaths, primarily secondary to acute myocardial infarction (58.3%), cardiac arrest (6.1%) and coronary perforation (3.5%). Noncardiac causes accounted for 19.1% of deaths and included infection (6.1%), aortic dissection (3.5%), acute respiratory failure (3.5%) and stroke (2.6%). Patients who died from cardiogenic shock had high rates of LVAD use (47.8%), 14.3% of whom required escalation. Periprocedural death after PCI occurred in 0.5% of all cases, was more common in highly complex lesions and was associated with presentation acuity. Cardiogenic shock was the most common cause of death.