In-Hospital Mortality of Index Percutaneous Coronary Intervention in Patients With and Without Prior Percutaneous Revascularization: A Single-Institution Analysis.

Percutaneous coronary intervention (PCI) is increasingly performed for symptom relief and survival benefit, particularly in patients presenting with acute coronary syndromes. It remains controversial whether prior PCI, and specifically when index PCI is performed on previously treated lesion(s), affects peri-procedural and in-hospital mortality. We queried an institutional PCI registry for all unique patients undergoing PCI during a 4-year period and classified them as having had or not prior PCI. If prior PCI had occurred, we further defined index PCI as a target lesion (TLR) PCI or non-TLR PCI, according to lesion(s) treated during the prior PCI. Multivariable analysis was performed to identify predictors of in-hospital mortality. Prior PCI was an independent predictor of in-hospital survival or lower mortality (HR 0.41 [0.22–0.76], P = 0.004), together with lower age (per 5 years, HR 0.73 [0.66–0.82], P < 0.001) and elective PCI (HR 0.63 [0.58–0.70], P < 0.0001). Among prior PCI patients, TLR PCI was associated with higher mortality (HR 3.03 [1.05–8.33]. P = 0.045), while elective PCI status was associated with lower mortality (HR 0.10 [0.01–0.80], P = 0.03). This excess mortality was only present in non-elective PCI cases (P INT = 0.02). We conclude that PCI mortality risk is decreased in patients with prior PCI, particularly when index PCI is performed electively on a lesion not previously treated. • In-hospital mortality of patients undergoing PCI is affected predominantly by age and clinical presentation. • Prior PCI is associated with lower in-hospital mortality during index PCI TLR-PCI is associated with increased in-hospital mortality when performed in ACS setting. [ABSTRACT FROM AUTHOR]