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