Outcomes of PCI at Hospitals with or without On-Site Cardiac Surgery

Abstract

We found that PCI performed at hospitals without on-site cardiac surgery was noninferior to PCI performed at hospitals with on-site cardiac surgery with respect to mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded by the Cardiovascular Patient Outcomes Research Team [C-PORT] participating sites; ClinicalTrials.gov number, NCT00549796.).

SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology–Association canadienne de cardiologie d'intervention)*

“…Less experienced operators should have additional oversight, such as backup support. The CPORT-E Trial serves as a model for facilities performing PCI without on-site cardiac surgery [8]. Consistent with its design, such facilities should participate in national registries, routinely utilize riskadjustment tools, have immediately available consultation with a tertiary care center, implement crosstraining of personnel, and have a well-developed system for expeditious transfer for emergency coronary artery bypass graft (CABG).…”

SCAI/ACC/AHA Expert Consensus Document

“…In 1 meta-analysis, after adjusting for publication bias, the mortality rate for nonprimary PCI was 25% higher at centers without on-site surgery compared with centers that had on-site surgery (OR, 1.25; 95% CI, 1.01-1.53; P ¼ 0.04) [20]. However, it is important to note that these meta-analyses preceded the publication of the 2 randomized trials [9,11]. Therefore, based on these [2,24,25].…”

“…Since 2006, 11 original studies and 3 meta-analyses on the topic of PCI without on-site surgery have been identified by a computerized systematic literature search using Medline (PubMed and Ovid) and Cochrane Databases [9,[11][12][13][14][15][16][17][18][19][20][21][22][23].…”

“…Both CPORT-E and MASS-COMM studies provide guidance contained in their on-line supplementary materials [9,11]. Both require a transport vehicle to be available to begin transport within 30 min and arrival at the surgical hospital within 60 min of the decision to declare the need for emergency surgery.…”

The Challenges of Success

“…In recent years, this proliferation has been aided, in part, by data suggesting that PCI can be performed safely without on-site cardiac surgery. 9,10 Given the aforementioned association between PCI volume and outcomes, the net effect of any such growth is likely to represent a complex balance between improved access and decreasing procedural volumes (both for hospitals and operators).…”