An extensive new analysis presented at the 2026 European Association of Percutaneous Cardiovascular Interventions (EAPCI) Summit challenges conventional expectations regarding the life-saving impact of primary percutaneous coronary intervention (PCI) on acute myocardial infarction (MI) mortality rates across Europe. The investigation, conducted by researchers from King’s College London, harnessed a rich amalgamation of data drawn from the ESC Atlas of Cardiology, the ESC Atlas in Interventional Cardiology, as well as supplementary inputs from the World Health Organization, the Institute for Health Metrics and Evaluation, and Eurostat. Covering 21 European countries, the study aimed to unravel the relationship between the prevalence of primary PCI procedures and the corresponding mortality rates following acute MI, factoring in critical socioeconomic and clinical variables such as cardiovascular disease (CVD) burden and gross domestic product (GDP) per capita.
Primary PCI is globally recognized as an essential intervention for promptly restoring coronary artery patency following the abrupt occlusion that typifies MI. Deployed as an emergent catheter-based procedure through femoral or radial arterial access, PCI often incorporates the strategic placement of coronary stents to re-establish myocardial perfusion, thereby mitigating ischemic damage. Conventional clinical wisdom and randomized controlled trials have long underscored the unequivocal survival benefit of rapid primary PCI in acute coronary syndrome management, typically associating expanded procedural volumes with improved population health outcomes. Yet, this comprehensive cross-national inquiry reveals a paradoxical trend: an increased rate of primary PCI procedures per million inhabitants correlates with heightened age-standardized MI mortality after adjusting for economic and disease burden confounders.
The investigators utilized sophisticated statistical adjustments for GDP per capita and regional CVD prevalence to evaluate the association between procedural frequency and MI mortality. Intriguingly, while wealthier countries exhibited expectedly lower age-standardized MI mortality rates—corroborated by a moderate negative population correlation coefficient of -0.54—a greater prevalence of cardiovascular morbidity positively correlated with elevated mortality rates (correlation coefficient +0.45). However, the unexpected finding emerged after adjustment: a moderate positive correlation (coefficient +0.68, p<0.001) indicated that regions performing higher volumes of primary PCI did not exhibit the anticipated decline in MI-related deaths. This suggests complex underlying factors influencing outcomes beyond mere procedural numbers.
Further analysis delved into the role of interventional cardiologist workload, unveiling a weak inverse correlation (-0.27, p=0.23) between the number of primary PCI cases performed per operator and MI mortality rates. Although this relationship lacked statistical significance, it hints that the operator’s procedural experience and expertise may subtly modulate outcomes, consistent with evidence supporting procedural proficiency as a determinant of success in complex coronary interventions. The findings intimate that center-level variables such as staffing qualifications, expertise, and workflow efficiency might critically influence the life-saving potential of PCI.
Leading the research team, Dr. Ali Malik highlighted the complexity of disentangling the multifaceted contributors to these counterintuitive observations. Despite PCI’s established efficacy, “significant variability exists at local, national, and regional levels in primary PCI delivery and associated patient outcomes.” Dr. Malik emphasized ongoing analyses aimed at exploring temporal factors such as pre-hospital delays, inter-hospital transfer logistics, and disparities in healthcare system infrastructure that may blunt PCI’s beneficial impact in certain regions.
Sukruth Pradeep Kundur, co-investigator, further elaborated on the systemic factors influencing outcomes. “It is plausible that inter-center variability and the interval between symptom onset and access to primary PCI play pivotal roles in modulating mortality,” he noted. This suggests that while increasing procedural capacity is necessary, it is insufficient without optimizing rapid diagnosis, efficient referral pathways, and minimizing total ischemic time—a critical determinant of myocardial salvage and survival.
The senior author, Dr. Sanjay Sivalokanathan from Mount Sinai Health System, contextualized these findings within the broader epidemiological landscape shaped by the global rise in cardiometabolic risk factors, including diabetes mellitus, obesity, and hypertension. “The increasing clinical complexity of patients presenting with acute coronary syndromes imposes formidable challenges on PCI efficacy,” Dr. Sivalokanathan remarked. He underscored the exigency for operator proficiency and advanced interventional techniques to navigate the anatomical and physiological intricacies of these high-risk populations, advocating for multidisciplinary collaboration as a keystone in modern cardiovascular care.
This pivotal study underscores the paramount importance of preventive cardiology as the fundamental strategy to reduce the burgeoning global burden of cardiovascular disease and downstream mortality. By highlighting the disconnect between procedural volumes and survival benefits, it calls for nuanced, system-wide approaches that integrate socioeconomic determinants, healthcare resource distribution, and timely access to interventions. The evidence advocates a shift from singular focus on procedural proliferation towards enhancing quality, expertise, and holistic patient management.
The research draws vital attention to geographical health disparities across Europe, shaped by varying GDP levels and cardiovascular wellness indices. It challenges cardiology stakeholders to interrogate existing models of care delivery and to refine resource allocation tailored to regional epidemiological realities. These compelling insights will undoubtedly stimulate vigorous discourse at the EAPCI Summit and within the wider cardiology community, potentially catalyzing transformative practices to optimize cardiovascular outcomes.
In summation, the relationship between primary PCI provision and MI mortality is demonstrably complex and influenced by interrelated clinical, operator-dependent, and socioeconomic variables. While primary PCI remains a cornerstone of acute MI management, its lifesaving efficacy at the population level depends on holistic integration with systemic healthcare factors. Future research should aim to elucidate precise mechanisms underpinning the observed associations and to develop strategic interventions fostering equitable access, operator excellence, and patient-centered care pathways across Europe.
Subject of Research:
The population-level relationship between primary percutaneous coronary intervention (PCI) provision and acute myocardial infarction (MI) mortality across multiple European countries, accounting for economic status and cardiovascular disease burden.
Article Title:
Cross-Sectional Analysis of Primary PCI Provision and Acute MI Mortality in Europe: Socioeconomic and Clinical Burden Considerations.
News Publication Date:
20 February 2026.
Web References:
- European Society of Cardiology (ESC) Atlas of Cardiology: https://eatlas.escardio.org
- ESC Atlas in Interventional Cardiology: https://www.escardio.org/communities/associations/eapci/advocacy/eapci-atlas/
- EAPCI Summit 2026 scientific programme: https://esc365.escardio.org/EAPCI-Summit
References:
- Malik A, Kundur S.P., et al. Cross-sectional analysis of primary PCI provision and AMI mortality across Europe: accounting for economic and disease burden. EAPCI Summit, 2026.
- Van Belle E, Parma R, Teles RC, et al. Atlas of interventional cardiology 2023: European Society of Cardiology and European Association of Percutaneous Coronary Interventions. Eur Heart J. 2025 Aug 29:ehaf698. doi:10.1093/eurheartj/ehaf698.
Keywords:
Primary percutaneous coronary intervention, acute myocardial infarction, cardiovascular disease, mortality rates, interventional cardiology, health economics, healthcare disparities, cardiovascular epidemiology, operator expertise, European cardiology.
