Dr KK Aggarwal
No surgery is safe. In every
so-called safe surgery, one should take consent about unexpected complications
and chances of death on the table or proximal
optimization technique (POT) stenting.
A new European registry
analysis presented at the Congress of the European Association of Percutaneous
Cardiovascular Intervention (EuroPCR) 2019 has identified high rates of
unexpected cardiac arrest and death in patients undergoing elective
percutaneous coronary intervention (PCI).
An analysis of more than
113,000 elective cases performed at high-volume PCI centers
shows that 330 patients arrested during PCI, or one per 344
procedures.
Of these, 162 patients
actually died on the table (20%) or during the first 24 hours (29%),
corresponding to one death per 702 procedures. Survival was
independent of the cause of cardiac arrest. Mortality in these patients is
always around 50% if someone arrests on your table.
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 coronary artery bypass graft surgery, mortality was quite
high, at 62%.
All patients who were referred
for surgery with a coronary perforation died.
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
