Incidence and Predictors of Procedural Intubation During Percutaneous Coronary Intervention

Background Pre-procedural fasting is employed prior to percutaneous coronary intervention (PCI) to prevent pulmonary complications in event of procedural intubation. This study aimed to identify the incidence and predictors of procedural intubation during PCI. Methods A retrospective analysis was conducted on patients undergoing PCI between 2014–2021 within the Victorian Cardiac Outcomes Registry. Patients were classified into urgent, semi-urgent, or elective PCI based on recorded PCI indication. Patients undergoing semi-urgent or elective PCI were presumed to be fasted pre-procedurally. Incidence of procedural intubation was reported. Inverse probability treatment weighting was used to determine associations between 30-day mortality and procedural intubation. Logistic regression was performed to determine clinical, procedural, and lesion predictors for procedural intubation among fasted patients. Results Among 83,929 patients, the incidence of procedural intubation was 0.5% and highest in urgent PCI procedures (OR 19.68, 95% CI 13.91–27.86, p<0.01). Procedural intubation was associated with increased 30-day mortality (OR 4.79, 95% CI 3.29–6.96, p<0.01). Among fasted patients, eGFR (OR 0.99, 95% CI 0.98–0.99, p<0.01), cardiogenic shock (OR 96.24, 95% CI 56.01–165.35, p<0.01), out-of-hospital cardiac arrest (OR 3.42, 95% CI 1.30–8.97, p=0.01), femoral access (OR 2.09, 95% CI 1.38–3.19, p<0.01), left main disease (OR 5.77, 95% CI 3.16–10.54, p<0.01), type C lesions (OR 3.86, 95% CI 1.19–12.56, p=0.03), and rotational atherectomy (OR 2.20, 95% CI 1.03–4.69, p=0.04) were associated with procedural intubation. Conclusion The incidence of intubation during PCI was low despite an association with worse 30-day mortality. Strict pre-procedural fasting may be unnecessary and could be specifically targeted at higher risk groups.