2010–2022 in-hospital mortality and causes of death after elective PCI in China: a multicenter real-world study

Background In-hospital mortality and causes of death after elective percutaneous coronary intervention (PCI) are not well elucidated in contemporary practice. Purpose To investigate causes of in-hospital death in patients undergoing elective PCI. Methods Data were derived from the Beijing PCI (BJ-PCI) registry between 2010 and 2022. Across 60 hospitals in Beijing, patients who underwent elective coronary procedures were screened. Information of in-hospital deaths were submitted to the Beijing Quality Control and Improvement Center for Cardiovascular Intervention every month. The causes of death were judged and finally confirmed by a review board quarterly, and were classified as procedure-related or disease-related. Results Among 1,907,498 patients who underwent elective coronary procedures from 2010 to 2022, 644,577 patients receiving elective PCI were included. A total of 720 in-hospital deaths were reported, with a overall in-hospital mortality of 0.11% (ranging from 0.08% to 0.15% across years). There were 389 (53.89%) deaths were procedure-related, with mechanical complications of 22.36% , stent thrombosis of 13.47%, and acute coronary occlusion of 12.22%, aortic dissection of 2.78%, PCI-related bleeding of 2.08%, and anaphylactic shock of 1.11%. In 331 (46.11%) patients with disease-related deaths, heart failure was the first cause of death contributing to 18.47%, followed by multiple organ failure of 9.31%. Ischemic stroke of 7.64% , severe infection of 6.81%, and pulmonary embolism of 2.08%. Compared with disease-related deaths, patients with procedure-related deaths were younger (68.20±10.52 vs 72.34±10.70 years, p<0.001) and more often died within 72 hours after PCI (59.38% vs 22.36%, p<0.001). Hospitals with annual PCI volumes above the median (>327 cases/year) had lower mortality than those below the median (0.067% vs 0.538%, p < 0.001). Tertiary hospitals demonstrated a lower mortality than non-tertiary hospitals (0.074% vs 0.288%, p < 0.001). Conclusion In-hospital mortality after elective PCI persistently at a low level in Beijing from 2010 to 2022, more than half of deaths were attributable to procedure-related complications. Mortality differed substantially by hospital PCI volume and hospital level.