Rates of Intraprocedural Adverse Events and Supportive Interventions During Percutaneous Coronary Interventions: A Single-Center, Retrospective Analysis

Ryan Quinn, MD, FRCPC; Aiman Alak, MD, FRCPC; Madhu Natarajan, MD, FRCPC, MSc;,,Ahmad Alshatti, MD, MRCP; Hussain Alzayer, MD, FRCPC; Matthew Sibbald, MD, FRCPC, MSc, PhD,,,,McMaster University, Department of Medicine, Division of Cardiology, Hamilton, Ontario, Canada,,,,

Single-Center Study

Rates of Intraprocedural Adverse Events and Supportive Interventions During Percutaneous Coronary Interventions: A Single-Center, Retrospective Analysis

Ryan Quinn, MD, FRCPC; Aiman Alak, MD, FRCPC; Madhu Natarajan, MD, FRCPC, MSc;
Ahmad Alshatti, MD, MRCP; Hussain Alzayer, MD, FRCPC; Matthew Sibbald, MD, FRCPC, MSc, PhD

McMaster University, Department of Medicine, Division of Cardiology, Hamilton, Ontario, Canada

July 2021

Editor's note: A pdf of this article is available for download at right (look for red pdf icon).

Abstract

Background: In percutaneous coronary intervention (PCI) literature, major adverse events such as stroke, myocardial infarction (MI), bleeding, or death have been well studied. However, no studies have evaluated the types and rates of adverse events requiring intraprocedural supportive interventions that occur during PCI. We believe these may represent harbingers of future major adverse cardiovascular events (MACE).

Methods: We performed a retrospective chart review of 474 patients who received PCI from January to December 2017 at a single tertiary care center in Ontario, Canada. The primary outcome was a composite of any pharmacologic or mechanical intraprocedural supportive interventions. Secondary outcomes included the composite of any pharmacologic intraprocedural supportive interventions, the composite of any mechanical intraprocedural supportive interventions, and each intraprocedural supportive intervention analyzed separately. A univariate and multivariate regression analysis was performed on demographic and procedural variables.

Results: Over half (51.3%) of all patients received some form of intraprocedural supportive intervention, either pharmacologic or mechanical. One out of every six patients (16.0%) required two or more intraprocedural supportive interventions during their procedure. Compared to patients with elective PCI, those presenting with a non ST-elevation MI (NSTEMI) had a higher risk of requiring intraprocedural supportive interventions, with an odds ratio (OR) of 1.962 (confidence interval [CI] 1.021 to 3.771, P=.043) and those presenting with ST-elevation MI (STEMI) had an OR of 3.304 (CI 1.747 to 6.246, P<.001).

Conclusion: During PCI, there is a high rate of events that require some form of intraprocedural supportive intervention. Those who present with NSTEMI and STEMI are at a higher risk of requiring intraprocedural supportive interventions. These may represent sentinel events for major adverse patient events and the anticipation of cases that have a higher chance of requiring intraprocedural supportive interventions may improve coordinated team dynamics.

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