Tuesday, June 11, 2019

Cardiac arrest during elective stenting

As per a new registry, 2 patients will die per year in centres doing 1500 stentings per year and 4 will have cardiac arrest on the table due to the procedure. The number may be much higher for low volume centres.

(Medscape Excerpts): A European registry has shown high rates of unexpected cardiac arrest and death in patients undergoing elective percutaneous coronary intervention. The analysis of over 113,000 elective cases performed at 11 high-volume PCI centers (> 1500 cases per year) shows that 330 patients arrested during PCI, or one per 344 procedures; of which 162 patients died on the table or during the first 24 hours corresponding to one death per 702 procedures.

Mortality is 50% if someone arrests on the table as per Dr Koen Ameloot Ziekenhuis Oost-Limburg, Genk, Belgium.

More than half (55%) the patients had a SYNTAX 1 score below 20 and 52% had a normal left ventricular ejection fraction.

The cause of cardiac arrest was technical complication (39%) or cumulative ischemia (32%); acute stent thrombosis (7%), no reflow (7%) and miscellaneous (13%).

Technical complications, such as dissection, perforation, bleeding, stroke, and stent loss, occurred in both low- and high-risk patients, whereas cumulative ischemia typically happened in high-risk PCI patients with many coronary manipulations.

Patients with a low SYNTAX score or normal ejection fraction typically arrested because of a technical complication, the proportion arresting because of cumulative ischemia rose with increasing SYNTAX score and worsening ejection fraction. Prognosis was worse if the LVEF was less than 35% and the SYNTAX score more than 30; mortality was inversely related to both.

Among the 29 patients who underwent salvage bypass surgery, mortality was quite high, at 62%. And, "remarkably, all patients who were referred for surgery with a coronary perforation died. 

Patients with a SYNTAX score above 30 and an ejection fraction below 35% most often died because of cumulative ischemia on the table.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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