Percutaneous Coronary Interventions can be performed in centers without on-site cardiac surgical back-up
March 29, 2008 By Lauren Ciaglo
SCAI-ACCi2 08-Chicago, IL:: An analysis from the National Cardiovascular Data Registry demonstrates that percutaneous coronary intervention (PCI) can be performed safely and successfully at medical facilities without on-site cardiac surgical back-up.
This study was presented today by Dr. Michael Kutcher at the SCAI-i2 summit Annual Scientific Sessions in Chicago.
The Atlantic C-PORT trial (Cardiovascular Patients Outcomes Research Team) was one of the initial studies that demonstrated that PCI is feasible in centers without surgical back-up [1]. THowever, this study was criticized for its early termination due to funding issues. It is not clear if performing PCI in a non cardiac surgery centers is effective and feasible. In many centers, primary PCIs are performed without cardiac surgical back-up.
To explore this further, Dr. Kutcher and colleagues from the NCDR performed an analysis from the CathPCI Registry. This study consisted of 9,029 patients treated with percutaneous coronary intervention (PCI) at 61 medical centers without surgical back-up and 299,132 patients treated at 404 medical centers with on-site cardiac surgical backup.
More patients underwent primary PCI at centers without surgical backup compared with centers with on-site surgical programs (50.6% vs. 28.9%). There was however no significant difference in rates of procedural success (94% vs. 93%) and in the occurrence of adverse events such as overall complications (6.4% vs. 6.3%), emergency surgery (0.31% vs. 0.37%), and mortality with emergency surgery (13.64% vs. 12.59%) between the two groups.
Another analysis based on risk adjustment demonstrated that on-site centers were more likely to perform emergency coronary artery bypass surgery (CABG). But the overall in-hospital mortality did not differ between the on-site vs. off-site groups (OR, 1.08, p=0.507), nor did mortality in primary PCI patients (OR, 1.02, p=0.881), mortality in non-primary PCI patients (OR, 1.12, p=0.444), emergency CABG (OR, 1.59, p=0.049), or mortality in patients not requiring emergency CABG (OR, 1.05, p=0.671).
Among centers with off-site programs versus on-site programs, 30% vs. 94% performed > 200 PCI procedures annually and only 43% vs. 80% performed > 36 primary PCIs annually (p<0.0001). This study also demonstrated that the off-site hospitals took on higher-risk patients. On an average 41% vs. 21% of patients experienced a myocardial infarction at the time of PCI in the off-site and on-site program hospitals respectively (p<0.0001).
This study therefore demonstrates that PCI is feasible in centers without surgical back up. However the results of this study should be interpreted in the context that the off-site centers included in this study had dedicated staff and facilities, the travel time, distances, and the modality of transport are generally within range for timely transfer to the off-site surgery center. In addition, 92% of sites provide 24/7 coverage and all the sites were committed to provide primary PCI for ST elevation myocardial infarction.
Source
Late Breaking Clinical Trials Session: SCAI Annual Scientific Sessions in partnership with ACC i2 summit, March 29-April 1, 2008 Chicago