• National Confidential Enquiry into Peri-Operative Deaths
• coronary angioplasty

• CABG, coronary artery bypass graft
• NCEPOD, National Confidential Enquiry into Peri-Operative Deaths
• NHS, National Health Service
• PTCA, percutaneous transluminal coronary angioplasty

Since 1987 the National Confidential Enquiry into Peri-Operative Deaths (NCEPOD) has undertaken detailed peer review of the clinical details of patients who died following anaesthesia and various surgical procedures. Their annual reports have reviewed the quality of care delivered, not specifically the causes of death, and attempted to identify potentially remediable factors in clinical practice. Last year NCEPOD published a study of a percutaneous “minimally invasive” procedure attempting to review all deaths within 30 days of a coronary angioplasty (PTCA) procedure in the UK between September 1998 and August 1999.¹ What observations were made?

All UK intervention centres were invited to participate, and 84% (n = 36) of National Health Service (NHS)—but only 38% (n = 5)—of private, intervention centres returned data. A total number of 21 222 PTCA procedures were performed with an overall mortality calculated to be 0.87%, validating the figure of 0.91% independently reported by the British Cardiovascular Intervention Society.² All deaths occurring in hospital were identified, but data collection systems were less robust for any death occurring in the community and a few may have been missed. Data were complete for 121 deaths and these formed the main basis of the report. The majority of those who died were high risk cases before the angioplasty procedure was undertaken; a high proportion had some form of acute coronary syndrome (85%), 62% had PTCA undertaken for acute myocardial infarction, 63% had moderate or severe left ventricular dysfunction, and 33% were in cardiogenic shock. Only 10% of the …