Nonemergent percutaneous coronary intervention safe without on-site cardiac surgery services

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1. Major adverse cardiac event rates at 30 days and 12 months after percutaneous coronary intervention are similar at hospitals with or without on-site cardiac surgery.

2. Procedural success rates are similar with or without on-site cardiac surgery while outcomes vary based on the hospitals.

Published today, this randomized study found that the safety and efficacy of PCI were noninferior at hospitals without on-site cardiac surgery. Previous studies have shown similar results. The results support more flexibility in choosing hospitals for patients seeking elective or non-emergent PCI. This is reassuring to patients in rural or medically underserved areas who may desire elective PCI but are concerned about the lack of cardiac surgery back-up at their local community hospitals.

In addition, this study revealed that outcomes differed among hospitals. Presuming that randomization was adequate, this heterogeneity suggests that comprehensive reviews and outcome assurances may be necessary as we certify new PCI programs.

Click to read the study in NEJM

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1. Major adverse cardiac event rates at 30 days and 12 months after percutaneous coronary intervention are similar at hospitals with or without on-site cardiac surgery.

2. Procedural success rates are similar with or without on-site cardiac surgery while outcomes vary based on the hospitals.

This [randomized controlled] study assessed the impact of on-site cardiac surgery services on the safety and efficacy of PCI. Patients were randomized at a 3:1 ratio to undergo non-emergent PCI at hospitals without or with on-site cardiac surgery. Rates of MACE – defined as a composite of death, myocardial infarction, repeat revascularization, or stroke – were compared at 30 days and 12 months.

At 30 days, MACE occurred in 9.5% of patients assigned to sites without on-site cardiac surgery, compared to 9.4% with on-site cardiac surgery (p<0.001 for noninferiority). The MACE rates at 12 months were 17.3% vs 17.8% (p<0.001 for noninferiority).

Additionally, angiographic review showed no difference in procedural success rates between cohorts. Outcomes varied among hospitals, with median odds of 1.3 at 12 months– suggesting MACE may be 1.3 times as likely at one facility compared to another. The median odd was 1.5 at 30 days.

In sum: Published today, this randomized study found that the safety and efficacy of PCI were noninferior at hospitals without on-site cardiac surgery. Previous studies have shown similar results. The results support more flexibility in choosing hospitals for patients seeking elective or non-emergent PCI. This is reassuring to patients in rural or medically underserved areas who may desire elective PCI but are concerned about the lack of cardiac surgery back-up at their local community hospitals.

In addition, this study revealed that outcomes differed among hospitals. Presuming that randomization was adequate, this heterogeneity suggests that comprehensive reviews and outcome assurances may be necessary as we certify new PCI programs.

Click to read the study in NEJM

By Xiaozhou Liu and Marc Succi

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