1. 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

2. 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

3. PERCUTANEOUS CORONARY INTERVENTION (PCI)

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

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

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

7. 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

8. 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%

9. COMPLICATIONS BY PROCEDURE ACUITY

10. COMPLICATIONS BY ACCESS SITE

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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