Munich, Germany – A surprising finding presented today at the EAPCI Summit 2026 challenges long-held assumptions about treating heart attacks. New data suggest that simply increasing the number of percutaneous coronary interventions (PCIs)—a life-saving procedure to restore blood flow during a heart attack—doesn’t automatically translate to lower mortality rates. The research, analyzing data from 21 European countries, raises important questions about optimizing cardiac care and the complex interplay between access to treatment, quality of care, and patient outcomes. This investigation into primary PCI utilization highlights the need for a more nuanced understanding of how to best combat acute myocardial infarction (MI).
PCI, often described as a critical intervention in the wake of a heart attack, involves physically opening blocked coronary arteries, typically using a stent. The procedure aims to quickly restore blood supply to the heart muscle, minimizing damage and improving chances of survival. While widely considered a cornerstone of modern cardiology, the new analysis suggests that simply doing *more* PCIs doesn’t necessarily equate to saving more lives. Researchers are now focusing on identifying the factors that truly drive positive outcomes.
A Complex Picture of PCI and Mortality
The study, led by Ali Malik from King’s College London, UK, analyzed data from the ESC Atlas of Cardiology and the ESC Atlas in Interventional Cardiology, integrating data from the World Health Organization, the Institute for Health Metrics and Evaluation, and Eurostat. The investigators assessed the relationship between the number of primary PCI procedures performed per million inhabitants and age-standardized acute MI mortality rates. Crucially, the analysis adjusted for factors like the prevalence of cardiovascular disease (CVD) and a country’s gross domestic product (GDP) per capita.
The findings revealed a moderate inverse correlation between GDP per capita and MI mortality rates—wealthier countries tended to have lower mortality rates (population correlation coefficient=−0.54; p=0.004). Conversely, a higher prevalence of CVD was associated with increased mortality (population correlation coefficient=+0.45; p=0.02). However, the most striking result was a moderate *positive* correlation between the rate of primary PCI procedures and MI mortality (population correlation coefficient=+0.68; p<0.001). This suggests that, after accounting for economic factors and disease prevalence, countries performing more PCIs didn’t necessarily see a corresponding decrease in deaths from heart attack.
Operator Expertise and Timely Intervention
Researchers are quick to emphasize that this doesn’t mean PCI is ineffective. Rather, it points to the importance of factors beyond sheer volume. “One would anticipate that increased provision of primary PCI would yield lower mortality rates,” explained Sukruth Pradeep Kundur, a co-investigator from King’s College London. “we will conduct additional analyses to elucidate why this trend is not evident in our preliminary findings.”
The team is now focusing on several key areas. One is the impact of operator experience. The data showed a weak inverse association between the number of primary PCI procedures performed *per interventional cardiologist* and MI mortality rates (population correlation coefficient=−0.27; p=0.23), hinting that specialized expertise may be a critical factor. Another area of investigation is the time elapsed between the onset of symptoms and access to PCI. Variations in practice between different centers and countries are also being examined.
The Role of Cardiometabolic Risk Factors
Doctor Sanjay Sivalokanathan, senior author from the Mount Sinai Health System in New York, USA, underscored the growing complexity of patients presenting with acute coronary syndromes. “The global rise in cardiometabolic risk factors appears to play a meaningful role in the clinical complexity of patients presenting with acute coronary syndromes,” he stated. “As such, PCI may be challenging in certain settings, highlighting the importance of operator experience and advanced interventional strategies.”
The findings emphasize the need for a holistic approach to cardiovascular care, one that prioritizes not only timely intervention but also prevention, risk factor management, and ensuring that procedures are performed by experienced specialists. The research team believes that collaborative, multidisciplinary approaches are essential to reducing the overall burden of cardiovascular disease and associated mortality.
The ongoing analyses promise to provide a more detailed understanding of the factors influencing PCI outcomes. Researchers expect to publish further results in the coming months, offering valuable insights for healthcare providers and policymakers seeking to improve cardiac care across Europe and beyond. The next step will be to delve deeper into the data, examining specific procedural techniques and patient characteristics to identify best practices and areas for improvement.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. We see essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
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