Munich, Germany – Results presented today at the inaugural EAPCI Summit 2026 indicate that an increase in percutaneous coronary intervention (PCI) procedures across Europe has not correlated with a reduction in mortality rates following acute myocardial infarction (MI), commonly known as a heart attack. The EAPCI Summit, organized by the European Association of Percutaneous Cardiovascular Interventions, a branch of the European Society of Cardiology (ESC), highlighted a surprising trend identified through analysis of extensive cardiovascular data.
Primary PCI, a procedure designed to rapidly restore blood flow to blocked coronary arteries – often utilizing stents – is a standard treatment for heart attacks. Despite increased access to and utilization of PCI across the continent, the data suggest this has not translated into improved patient survival. “It is well established that primary PCI plays a pivotal role in reducing mortality after MI; however, significant variability exists at local, national and regional levels in the provision of primary PCI and associated patient outcomes,” stated Ali Malik of King’s College London, who presented the study findings.
The investigation integrated data from the ESC Atlas of Cardiology and the ESC Atlas in Interventional Cardiology, alongside datasets from the World Health Organization, the Institute for Health Metrics and Evaluation, and Eurostat, encompassing 21 European countries. Researchers assessed the relationship between the number of primary PCI procedures performed per million inhabitants and age-standardized acute MI mortality rates, accounting for factors such as gross domestic product (GDP) per capita and the prevalence of cardiovascular disease (CVD).
The analysis revealed a moderate inverse correlation between GDP per capita and MI mortality rates (population correlation coefficient=−0.54; p=0.004), indicating that wealthier nations tend to have lower mortality rates. Conversely, a higher prevalence of CVD was associated with increased mortality (population correlation coefficient=+0.45; p=0.02). However, unexpectedly, a moderate positive correlation emerged between the rate of primary PCI procedures and MI mortality (population correlation coefficient=+0.68; p<0.001) after adjusting for GDP and CVD prevalence.
A weak inverse association was also observed, suggesting that a higher volume of primary PCI procedures performed per interventional cardiologist may be linked to lower MI mortality rates (population correlation coefficient=−0.27; p=0.23), though this finding was not statistically significant. Researchers emphasized the need for further investigation into these preliminary results.
“One would anticipate that increased provision of primary PCI would yield lower mortality rates; we will conduct additional analyses to elucidate why this trend is not evident in our preliminary findings,” explained Sukruth Pradeep Kundur, a co-investigator from King’s College London. “The observed association with procedural workload highlights the significance of operator expertise. System-level factors include inter-centre variability and the interval between symptom onset and access to primary PCI.”
Senior author Sanjay Sivalokanathan, from the Mount Sinai Health System in New York, USA, noted the increasing prevalence of cardiometabolic risk factors globally and their impact on the complexity of acute coronary syndromes. “As such, PCI may be challenging in certain settings, highlighting the importance of operator experience and advanced interventional strategies,” he said. “These developments emphasise the need for collaborative, multidisciplinary approaches, while prevention remains the cornerstone of reducing the overall burden of cardiovascular disease and associated mortality.”