Long-Term Mortality and Morbidity at One Year among Universal Coverage (UC) Thai Patients Undergone Coronary Angiography without Further Cardiac Interventions (CAG Only) from 2020 - 2022

Abstract

Coronary angiography (CAG) has been considered as a safe invasive procedure since it carries low mortality (<0.8%) and overall morbidity rates (<2.0%). Previously, our group reported a high short-term (in-hospital and 30 days) adverse events among 59,373 Thai patients underwent CAG Only from reimbursement data of the National Health Security Office (NHSO), Thailand 2016-2020, including death 2.90%, stroke 1.25% and acute kidney injury 7.50%. However, the claimed data did not provide clinical details to determine possible causes. Thus, NHSO had designed a short clinical data form to be filled up by service centers accompanying with reimbursement. However, low complications were reported from total CAG 5,019 cases, only 2.35% (95%CI 1.92, 2.78) including death, stroke, and acute renal failure (ARF) which 86.40% of them occurred within 24 hours of CAG Only suggestive of procedure-related events. Thus, we studied the long-term (from admission to one years) adverse clinical outcomes, including death, acute renal failure (ARF) and acute stroke, which had not been diagnosed before admission, of 53,300 patients underwent CAG Only (from total 141,605 CAG cases recorded) in the fiscal year 2020- 2023 of the NHSO system. It was found that proportion of CAG Only remained high, 37.63% (37.36-38.05%) among patients receiving CAG, and they carried a high in-hospital mortality rates of 2.6-2.7%. The highest mortality was observed in patients diagnosed with ischemic heart diseases (IHD), 7.15-8.06%, other cardiovascular diseases (CVD), 5.00-5.35%) and other diseases, 3.75-3.80%. Importantly, the mortality rates had increased by 1.5-1.7 times, from 7.5% (30 days) to 12.17% (one-year), accumulated to very high one-year mortality of 19.66% (18.71-20.22). We found relatively high rate of ARF, 4.24-5.37%, and acute stroke 1.05-1.28% which had not been diagnosed before admission. In addition, new diagnosis of ARF and acute stroke were re-admitted after CAG only, accumulated to the total average ARF of 9.54% and stroke of 3.46% which likely contributed to high one-year mortality. Conclusions: this analysis showed unacceptably high long-term mortality and morbidity of Thai patients undergone CAG Only. Although it could not be concluded as procedural related events but it should be a wake-up call for care providers, budget regulators and researchers, to improve case record details for risk factors, co-morbidities, to follow current practice standard guidelines and to provide preventive interventions for patient safety, hopefully to reduce unnecessary cost of these adverse events in the future.