Cardiologist Performs PCI but Results in Cardiac Arrest and Death

This cardiac radiology case involves a fifty-five-year-old male patient with diabetes, for which he was using Onglyza to treat, and hypertension. He presented to the hospital with complaints of chest pain, shortness of breath, left jaw and left shoulder pain, diaphoresis, and palpitations. After a complete workup, the patient was found to have an ST-elevation myocardial infarction of the left coronary artery. The patient was immediately transferred to the cardiac catheter lab to undergo percutaneous coronary intervention (PCI). During the procedure, the patient underwent ventricular fibrillation and eventually cardiac arrest. CPR and critical care management were performed, but the patient expired shortly thereafter.

Question(s) For Expert Witness

1. What are the accepted complications of percutaneous coronary intervention in the treatment of acute coronary syndrome?

Expert Witness Response E-001257

As compared to PCI procedures of the past, there have been numerous advances in the technique, technology, and medical therapy associated with the treatment of acute coronary syndromes. As such, the morbidity and mortality rates of percutaneous transluminal coronary intervention have greatly decreased. There are still a number of complications, however, that can occur during the procedure. Restenosis is a more common complication and typically requires a second revascularization procedure to continue treatment. Another complication that can occur is the presence of thrombi. These can sometimes form at the site of artery tears, which can lead to difficulty in breaking up clot formations. Of course, hematomas can develop at the site of catheter entry points. Lastly, arrhythmias can occur at any point during the procedure, which can result in cardiac arrest and even sudden cardiac death.