Complications Related to Access Site After Percutaneous Coronary Interventions: Are the Adverse Events Underreported?

Objectives: The primary objective was to compare the NCDR rate of four access site related complications (arteriovenous fistula, pseudoaneurysm, retroperitoneal bleed, and blood transfusion) with that obtained independently within a Quality Improvement (QI) Database. The secondary objective was to determine the in-hospital mortality related to these complications. Background: NCDR is the most comprehensive database of post-PCI patients and a method by which hospitals are compared for quality of care and outcomes. The collected data include in-hospital events only, therefore reporting for same day and/or early discharges may fail to capture adverse events. We hypothesized that the actual rate of complications post-PCI may be higher than the rate reported in NCDR. Methods: Adverse events following PCIs were collected in a QI database. We compared the rate of four abovementioned complications between NCDR and our QI database for the time period between January 1, 2005 and December 31, 2008. Results: A total of 3,940 PCIs were performed on 3,430 patients in the four-year interval. The incidence of the combined endpoint of the four adverse events was 4.1% (161 events) in NCDR, vs. 4.7% (186 events) in QI database, a 13% higher yield. There was significantly higher in-hospital mortality in the complication group with regards to both all cause (4.7% vs. 1.1%, P < 0.0001) and cardiovascular mortality (2.7% vs. 1%, P = 0.046). Conclusions: Access site related complications occurred 13% more than what was reported in NCDR and were associated with a greater than fourfold increase in in-hospital mortality. (C) 2011 Wiley-Liss, Inc.