PCI & Heart Attack Deaths: No Clear Link in Europe

A surprising trend has emerged from the inaugural EAPCI Summit 2026: despite a significant increase in the use of primary percutaneous coronary intervention (PCI) – a critical procedure for heart attack victims – mortality rates haven’t demonstrably decreased across Europe. This finding challenges long-held assumptions about the direct correlation between intervention volume and patient outcomes, and signals a need to reassess strategies for managing acute myocardial infarction (MI).

Primary PCI, involving the unblocking of coronary arteries using stents, has been a cornerstone of heart attack treatment for decades. The expectation has always been that wider access to and increased utilization of this procedure would directly reduce deaths. However, this study, analyzing data from the ESC Atlas of Cardiology and other sources, reveals a more complex picture. The researchers found a moderate *positive* correlation between PCI rates and MI mortality after adjusting for GDP and CVD prevalence – a counterintuitive result that demands further investigation.

This isn’t to say PCI is ineffective. As Ali Malik of King’s College London points out, significant variability exists in the provision of PCI and subsequent patient outcomes across different regions. The study highlights the influence of broader socioeconomic factors. The strong inverse correlation between GDP per capita and MI mortality underscores the impact of overall healthcare infrastructure, access to preventative care, and lifestyle factors. Conversely, the positive correlation between CVD prevalence and mortality isn’t surprising, but reinforces the urgency of preventative measures.

The finding regarding operator workload is particularly insightful. While simply doing more PCIs doesn’t guarantee better outcomes, concentrating procedures in the hands of experienced interventional cardiologists appears to be beneficial, albeit with a weak statistical significance in this initial analysis. This suggests that focusing on training, specialization, and maintaining high procedural volumes for individual cardiologists could be a more effective strategy than simply expanding access to PCI broadly.

The Forward Look

The implications of these findings are substantial. We can anticipate several key developments in the coming years. First, the ongoing statistical analyses promised by the research team will be critical. Specifically, a deeper dive into the reasons behind the positive correlation between PCI rates and mortality is needed. Are there specific patient populations where PCI is less effective? Are there systemic issues – such as delays in treatment or variations in post-PCI care – that are contributing to the lack of improvement in mortality rates?

Second, expect a renewed focus on optimizing PCI delivery systems. This will likely involve greater emphasis on regionalization of care, ensuring patients are transported to centers with experienced teams and appropriate infrastructure. Investment in training and continuing education for interventional cardiologists will also be paramount.

Finally, and perhaps most importantly, this study serves as a stark reminder that PCI is just one piece of the puzzle. As Dr. Sanjay Sivalokanathan of Mount Sinai Health System emphasizes, addressing the underlying cardiometabolic risk factors – such as obesity, diabetes, and hypertension – remains the cornerstone of reducing the overall burden of cardiovascular disease. Expect to see increased calls for public health initiatives focused on prevention and lifestyle modification, alongside continued advancements in interventional cardiology.