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Trends of in-hospital and 30-day mortality after percutaneous coronary intervention in England before and after the COVID-19 era

Mamas; Rashid

Trends of in-hospital and 30-day mortality after percutaneous coronary intervention in England before and after the COVID-19 era Thumbnail


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Abstract

Objectives: To examine short-term primary causes of death after percutaneous coronary intervention (PCI) in a national cohort before and during COVID-19. Background: Public reporting of PCI outcomes is a performance metric and a requirement in many healthcare systems. There are inconsistent data on the causes of death after PCI, and what proportion of these are attributable to cardiac causes. Methods: All patients undergoing PCI in England between 1st January 2017 and 10th May 2020 were retrospectively analysed (n=273,141), according to their outcome from the date of PCI; no death and in-hospital, post-discharge, and 30-day death. Results: The overall rates of in-hospital and 30-day death were 1.9% and 2.8%, respectively. The rate of 30-day death declined between 2017 (2.9%) and February 2020 (2.5%), mainly due to lower in-hospital death (2.1% vs. 1.5%), before rising again from 1st March 2020 (3.2%) due to higher rates of post-discharge mortality. Only 59.6% of 30-day deaths were due to cardiac causes, the most common being acute coronary syndrome, cardiogenic shock and heart failure, and this persisted throughout the study period. 10.4% of 30-day deaths after 1st March 2020 were due to confirmed COVID-19. Conclusions: In this nationwide study, we show that 40% of 30-day deaths are due to non-cardiac causes. Non-cardiac deaths have increased even more from the start of the COVID-19 pandemic, with one in ten deaths from March 2020 being COVID-19 related. These findings raise a question of whether public reporting of PCI outcomes should be cause-specific.

Acceptance Date Jul 27, 2020
Publication Date Jul 27, 2020
Journal Medrxiv
Publisher Cold Spring Harbor Laboratory Press
DOI https://doi.org/10.1101/2020.07.18.20155549v1
Keywords COVID-19; percutaneous coronary intervention; deaths; England; outcomes
Publisher URL https://www.medrxiv.org/content/10.1101/2020.07.18.20155549v1