Author + information
- Carl Backes,
- Bugsu Ovunc,
- Sarosh Batlivala,
- Sthuthi David,
- Kevin Kollins,
- Jonathan Rome,
- Lisa Bergersen and
- Ralf Holzer
30-day post-procedure mortality is commonly used as a quality outcome metric in surgical (STS) and cardiac catheterization (PCI) registries. It is unclear though, whether this parameter is sufficiently specific to meaningfully capture mortality attributable to cardiac catheterization in patients with congenital heart disease.
Multi-center cohort study with three participating tertiary referral centers. Source documents (medical records, autopsy data, imaging data) were retrospectively reviewed for patients who died within 30 days of cardiac catheterization performed between 01/2007 and 06/2012. Attributability of death was assigned to each case.
A total of 14,707 cardiac catheterization procedures were performed during the study period. Death occurred within 30 days in 281/14,707 (1.9%) of cases. 88% of cases were emergent or non-elective cases. The median age was 4.2 year (1d-46yr). The median interval between cardiac catheterization and death was 11.2 days (0d-30d). In 159/281 (57%) of cases, cardiac surgery and catheterization occurred within 30 days of each other. Death was likely or probably attributable to the catheterization procedure in 30/281 (11%) of cases. Catheterization related AE eventually resulting in death included primary arrhythmias (n=3), cardiac arrest (n=6), vascular or cardiac trauma (n=9), device related problems (n=1), neurologic injury (n=2), and other AE or hemodynamic compromise within 24 hours following the procedure (n=8). Death was attributable to cardiac surgery in 17%, pre-cath clinical status unrelated to cath or surgery in 26%, post-cath clinical status unrelated to cath or surgery in 28%, and non-cardiac comorbidity in 16%. In 2%, death attributability could not be clearly established.
In a large majority of children with congenital heart disease who die within 30 days of catheterization, the procedure appears not to be a major contributor to mortality. While valuable in other settings, unadjusted 30 day mortality may not be nearly as useful a quality metric for patients with congenital heart disease undergoing cardiac catheterization.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: Trends, Knowledge and Outcomes
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1161M-139
- 2013 American College of Cardiology Foundation