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Coronary angioplasty aka PCI is a common procedure with excellent success rates. The in-hospital mortality following PCI is 1-2% and in the setting of acute coronary syndrome is 3%. Additionally,1-2% of patients die after discharge within 30 days.

Two recent retrospective database analyses from the states of New York and Michigan Blue shield studied mortality after PCI 1,2. The New York database included 135,000 patients studying in-hospital and 30-day mortality while the Michigan database had 92,000 patients analysing in-hospital mortality.

I present these papers with the learning points so that we can improve patient outcomes.

coronary angioplasty

The findings

Both databases showed a 1.5% – 30-day mortality after PCI.
30% of these deaths are preventable.
Most in-hospital deaths were non preventable (70%). They were attributed to pre-existing cardiac conditions such as cardiogenic shock, left ventricular failure, comorbidities etc. Most of them are emergency and high-risk patients. 30% of in-hospital deaths are preventable and in most cases the indication for PCI was rarely beneficial.
After-discharge deaths accounted for 30% of the total 30-day mortality. Surprisingly, 60% of these deaths happened in non-emergency patients and in low-risk patients.
Most deaths that happened in low-risk patients were in whom the PCI was rarely indicated.
Procedural complications such as coronary perforation and rupture are extremely rare.

The learnings

Most deaths after discharge and 30% of in-hospital deaths are preventable and happened in low-risk PCI groups.
Patient selection using Appropriate Utility Criteria needs to be widely implemented.
Pre-procedure patient preparation by optimising co-morbidities and heart failure could improve the outcomes.
Post-discharge monitoring of patients could improve the outcomes.
Hospital quality metrics need to include both in-hospital and 30-day mortality following PCI rather than in-hospital mortality alone.

References

https://doi.org/10.1016/j.jscai.2022.100559.

https://doi.org/10.1371/journal.pone.0297596

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Many people have heart disease, but not all of them know it. Doctors use a variety of tests to identify cardiac ailments and their underlying causes. Coronary angiography is one of the most common diagnostic tests that doctors use.

While it’s considered a safe and minimally invasive procedure, coronary angiography comes with a few risks. You can read more about the potential risks and complications in our previous blog.

The good news is that you can avoid side effects with proper care after the procedure. If you’ve recently had coronary angiography or are going through one soon, here is what you need to do after the procedure:

Avoid Heavy Physical Activity

It’s important to rest after coronary angiography. Avoid lifting heavy objects or resuming your exercise routine right after the procedure. Make sure you get plenty of sleep and let your body and mind relax for at least a week after angiography. Ask your doctor if you’re unsure when to hit the gym or start exercising.

Embrace Healthy Habits

Avoid cigarettes for at least a few days if you are a smoker. Smoking can cause spasms in the coronary arteries, leading to a heart attack or stroke after your angiography. Also, avoid alcohol consumption, and make sure you eat a balanced diet.

If you are a coffee drinker or have high blood pressure, avoiding all caffeine products (coffee, tea) and salt for several days following your procedure may be a good idea. The most important thing is to listen carefully to what your doctor tells you about caring after coronary angiography to avoid any other complications during recovery or later down the road.

Be Careful About Removing the Bandage

A crucial step to caring after coronary angiography is to avoid removing the bandage until the morning of the second day after the procedure. Also, you should not remove it yourself. Let someone else help you remove it. You must consult your doctor or nurse before removing the bandage.

Expect Soreness and Pain for a Few Days

Your arm or leg (where the catheter was inserted) might feel sore for a few days following a coronary angiogram. The discomfort you feel is usually caused by the catheter or dye used for the test.

The catheter may have been left in place too long, leading to irritation and inflammation. Or it could be a reaction to the dye that was used to take images of your arteries during the procedure. It can also happen if you’re allergic to any component of either one.

In most cases, the pain and soreness should subside after a few days. If the pain persists or the arm/leg becomes numb, it’s a good idea to reach out to your doctor. Also, if you have a fever or trouble breathing, call your doctor right away.

If you are bleeding from the incision site, apply direct pressure with a gauze dressing until the bleeding stops. Don’t remove the dressing unless instructed by medical staff at the hospital.

Conclusion

Coronary angiography is a safe and effective procedure that can give you a better understanding of your heart health. If you follow your doctor’s instructions, you’ll be on the road to recovery in no time.

Dr. C Raghu is a renowned cardiologist who has treated thousands of patients with cardiac ailments. If you have any concerns or questions about coronary angiography, feel free to reach out to Dr. Raghu today.