Complication Rates for Percutaneous Coronary Intervention in South Australia Aashray Gupta1, Rosanna Tavella1,2, Margaret Arstall1,3, Matthew Worthley1,2, Derek Chew4,5, Christopher Zeitz1,2, John Beltrame1,2 1 Discipline of Medicine, The University of Adelaide 2 Central Adelaide Local Health Network, SA Health 3 Northern Adelaide Local Health Network, SA Health 4 School of Medicine, Flinders University 5 Southern Adelaide Local Health Network, SA Health

BACKGROUND Coronary Artery Disease (CAD) causes death and disability Often treated with Percutaneous Coronary Intervention (PCI) Contemporary complication rates of PCI are uncertain Currently based on historic data Important for advising patients of risk and benefits of procedure

PERCUTANEOUS CORONARY INTERVENTION (PCI)

PCI – BALANCING RISKS AND BENEFITS Potential Benefits Relieves chest pain Improves survival  MI  Re-hospitalisation Potential Risks Death Cardiac Complications Stroke Bleeding Kidney injury

PCI – CURRENT SA HEALTH CONSENT FORM Complications Rate (per 1000 procedures) Death 4 Heart Attack Stroke 1 Emergency Bypass Surgery 3 Kidney Damage 5

AIM To document contemporary complication rates of PCI using a statewide data-set Peripheral and Cardiac events

METHODOLOGY Coronary Angiogram Database Of South Australia (CADOSA) Registers all PCI Procedures in SA Public Hospitals Data collected by trained abstractor Standardised definitions Consistent with international studies

RESULTS – PATIENT CHARACTERISTICS All Procedures in 2013 (n = 1517) 74% of patients were male Average age: 63 ±12 years Acuity – 76% Acute, 24% Elective Access – 59% Radial, 41% Femoral PCI complication rate – 5.3%, Success Rate = 94.7% In-hospital Mortality Rate – 1.7%

COMPLICATIONS BY PROCEDURE ACUITY

COMPLICATIONS BY ACCESS SITE

RESULTS – PERIPHERAL COMPLICATIONS Rate (%) Acute Kidney Injury Minor Injury (Cr  30 µmol/L) 5.1 Major Injury (new dialysis) 0.3 Major Bleeding Hb  30 g/L 1.7 Blood Transfusion 0.9 Stroke Embolic Stroke Haemorrhagic Stroke

RESULTS – CARDIAC COMPLICATIONS Rate (%) New Cardiogenic Shock (BP < 90 mmHg) 2.4 New Congestive Heart Failure (CHF) 1.3 Periprocedural MI Emergency CABG 0.2

RESULTS – CARDIAC COMPLICATIONS Our Study Stathopoulos et al (2009) (N= 23,399) ACC PCI Guidelines** Mortality 1.7% 0.6% 1.3% Stroke 0.3% 0.2% Bleeding 2-6% Emergency CABG 0.4% Periprocedural MI 0.7% Major Kidney Injury Overall Rate 5.3% 3.4% *Stathopoulos et al, 2009, ** ACC/AHA PCI Guidelines 2011

RESULTS IN CONTEXT In-hospital Events SA Consent Form CADOSA (cases/1,000 procedures) Mortality 4 17 Stroke 1 3 Emergency CABG Periprocedural MI 13 Major Kidney Injury 5 Major Bleeding - New Cardiogenic Shock 24 New Heart Failure

CONCLUSIONS Actual complications differ from current consent form Rates of Mortality, Stroke, Periprocedural MI higher Rate of Major Kidney Injury lower Complication rates not previously reported: Bleeding New Cardiogenic Shock New Congestive Heart Failure

Need for ongoing surveillance of complications IMPLICATIONS Need for ongoing surveillance of complications Important to guide quality improvement efforts Essential for informed consent Need to update PCI consent form

ACKNOWLEDGEMENTS Supervisors Dr Rosanna Tavella Prof John Beltrame Collaborators from the CADOSA Registry