In-hospital and 30-day mortality after percutaneous coronary intervention in England before and after the COVID-19 era

  1. Mohamed O. Mohamed
  2. Tim Kinnaird
  3. Nick Curzen
  4. Peter Ludman
  5. Jianhua Wu
  6. Muhammad Rashid
  7. Ahmad Shoaib
  8. Mark de Belder
  9. John Deanfield
  10. Chris P Gale
  11. Mamas A. Mamas

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Abstract

Objectives

To examine short-term primary causes of death after percutaneous coronary intervention (PCI) in a national cohort before and during COVID-19.

Background

Public reporting of PCI outcomes is a performance metric and a requirement in many healthcare systems. There are inconsistent data on the causes of death after PCI, and what proportion of these are attributable to cardiac causes.

Methods

All patients undergoing PCI in England between 1 st January 2017 and 10 th May 2020 were retrospectively analysed (n=273,141), according to their outcome from the date of PCI; no death and in-hospital, post-discharge, and 30-day death.

Results

The overall rates of in-hospital and 30-day death were 1.9% and 2.8%, respectively. The rate of 30-day death declined between 2017 (2.9%) and February 2020 (2.5%), mainly due to lower in-hospital death (2.1% vs. 1.5%), before rising again from 1st March 2020 (3.2%) due to higher rates of post-discharge mortality. Only 59.6% of 30-day deaths were due to cardiac causes, the most common being acute coronary syndrome, cardiogenic shock and heart failure, and this persisted throughout the study period. 10.4% of 30-day deaths after 1 st March 2020 were due to confirmed COVID-19.

Conclusions

In this nationwide study, we show that 40% of 30-day deaths are due to non-cardiac causes. Non-cardiac deaths have increased even more from the start of the COVID-19 pandemic, with one in ten deaths from March 2020 being COVID-19 related. These findings raise a question of whether public reporting of PCI outcomes should be cause-specific.

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  1. ScreenIT

    SciScore for 10.1101/2020.07.18.20155549: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    SAGE supports UK cross-government decisions in the Cabinet Office Briefing Room (COBR)) and by NHS England, which overseas commissioning decisions in the NHS, and NHS Improvement, which is responsible for overseeing quality of care in NHS hospitals.
    SAGE
    suggested: (SAGE, RRID:SCR_009302)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    (24,25) (26) Strengths and Limitations: The present study is the largest to report trends of 30-day causes of deaths after PCI in a contemporary nationwide cohort, including both inpatient and outpatient procedures, making it generalizable to the wider population of interest. Another notable strength is our ascertainment and determination of cause of death, which is based on linkage to the ONS database and details from the Medical Cause of Death Certificate, unlike some previous studies. However, there are several limitations to the present study. First, whilst the BCIS dataset captures cardiovascular risk factors and procedural characteristics, it does not capture measures of comorbidity, such as Charlson or Elixhauser scores, or frailty that are important determinants of mortality post PCI. (27,28) The observational nature of our study means that residual unmeasured confounders such as these and others may not be accounted for. Third, given that these data are the most contemporary available (census June 2020 for procedures in May 2020) there is insufficient follow up to study longer term causes of death, particularly given that it has been shown in patients derived from RCTs that non-cardiovascular causes of mortality become more important at longer term follow up.(7) Finally, COVID-19 cases were identified according to the corresponding ICD-10 code (U07.1 – confirmed COVID). However, the data does not inform us of whether this confirmation was based on virology/ serology ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.07.18.20155549v1 on medRxiv