Intraprocedural Cardiac Arrest in Patients Undergoing Percutaneous Coronary Interventions in the United States

BACKGROUND Cardiac arrest (CA) during percutaneous coronary interventions (PCI) is a catastrophic procedural complication. Contemporary rates of CA during PCI are unknown. OBJECTIVES This study sought to understand contemporary rates of CA, associated mortality, and identify predictors of CA during PCI. METHODS Patients with CA during PCI from 2018 to 2023 were identified from the National Cardiovascular Data Registry CathPCI Registry. Trends in intraprocedural CA (IPCA) incidence and in-hospital death were evaluated. Predictors of IPCA and risk-adjusted mortality were identified. RESULTS A total of 36,755 IPCA occurred during 3,956,840 PCIs (0.93%), including in 0.24% of elective PCIs, 0.32% of PCIs for stable coronary artery disease, and 1.28% of acute coronary syndrome interventions. The incidence of IPCA increased over time (0.62% in 2018 to 1.07% in 2023; P < 0.0001). In-hospital death occurred in 40.5% of patients with IPCA, 45.4% of whom died in the cardiac catheterization laboratory. Notably, although risk-adjusted IPCA increased (0.79% to 0.95%; P = 0.042), slight declines in risk-adjusted mortality (45.1% to 43.6%; P = 0.027) were observed over time. PCI for ST-segment elevation myocardial infarction, non-ST-segment acute coronary syndromes, increasing age, ventricular arrhythmias, severe aortic stenosis, vasopressors or inotrope use, mechanical circulatory support, coronary perforation, coronary dissection, cardiac tamponade, intraprocedural heart failure or myocardial infarction, and temporary cardiac pacemaker implantation were associated with increased adjusted odds of IPCA. CONCLUSIONS IPCA complicates 0.93% of contemporary PCI. Despite an increasing incidence of risk-adjusted IPCA, there were slight declines in risk-adjusted in-hospital mortality in the study period. Several patient and procedural characteristics were independently associated with intraprocedural CA.