Abstract 82: Post Coronary Angioplasty; Why Did My Patient Die?

Introduction: PCI interventions carry the risk of mortality. Minimizing by appropriate selection of patients, procedural technique, aftercare is critical. Despite advances, mortality risk has not significantly changed. Registries have been developed to assess and report outcomes/quality of care. Methods: Mortalities identified in the National Cardiovascular Disease Registry [NCDR] database from 2017-2020 @ Stony Brook University Hospital were identified and reviewed. The 2017 mortalities were compared with Vizient [Analytics providing cost/quality/value benchmarking & practice improvement feedback] predictors of mortality (case mix index [CMI]) and NYS PCI database which use different risk adjusters. Results: There were 79 mortalities over 4 years (average age 79, M:F ratio 2.07 [54/26], 76 died in-house). Cause of death [59 cardiac, 8 neurologic, 4 infection, 1 hemorrhage, 1 pulmonary, 3 unknown; 10 cases attributed to surgery]. Mortality rates remained constant over time. Vizient expected mortality rates show poor correlation with NCDR predictions, which may reflect in part patient selection and unadjusted comorbidity. NCDR correlation with the more restrictive risk adjusted NYS DOH mortality rates is better than for Vizient. NCDR mortality for 2017 was 1.4% [21/1503]; NYS DOH 30 day reported OMR1.76%, EMR 1.36%, RAMR of 1.46% for all [26/1,476] cases and RAMR of 0.95% for non-emergent [1,150] cases. Conclusions: The NCDR provides a useful tool to benchmark PCI mortality, but unadjusted comorbidity, as demonstrated by mismatches in predicted outcomes] adversely affects observed mortality. Increased attention to patient selection may provide improvements in outcomes, decrease mortality risks, and improve value. Value: Improving patient selection improves NCDR mortality and result in lower costs and better reported outcomes. Patients, Providers and Payers may benefit from the provision of appropriate services and improved outcomes..