Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom

Garg, Scot; Anderson, Simon; Oldroyd, Keith G.; Berry, Colin; Emdin, Connor A.; Peters, Sanne A.E.; West, Nick E.J.; Kelly, Damian J.; Balachandran, Kanarath; McDonald, John; Singh, Ravi; Devadathan, Sen; Redwood, Simon; Ludman, Peter; Rahimi, Kazem; Woodward, Mark

doi:10.1016/j.jacc.2015.05.052

Cited by 24 publications

(26 citation statements)

References 16 publications

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“…The MASS COMM trial, published in 2013, used a similar study design and found 30-day and 12-month rates of MACE to also be non-inferior at hospitals without cSoS to sites with cSoS [2]. These findings have been reproduced in a retrospective analysis from the United Kingdom, where the majority of PCI facilities do not have cSoS, using a large non-PPCI cohort of 99,438 patients at centers without surgery versus 195,316 patients at centers with on-site surgery and showed no significant difference in mortality at 30 days, 1 year, and 5 years [17]. Observational data using the VA health care system clinical reporting and tracking analyzed sites with and without cSoS receiving PCI for all indications, including non-PPCI, demonstrated no differences in emergent CABG, 1-year adjusted mortality and myocardial infarction rates, while also increasing geographic access to VA patients [7].…”

Section: Plos Onementioning

confidence: 76%

Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience

et al. 2020

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Introduction Non-primary percutaneous coronary intervention (non-PPCI) recently received certificate of need approval in the state of Michigan at sites without cardiac surgery on-site (cSoS). This requires quality oversight through participation in the BMC2 registry. While previous studies have indicated the safety of this practice, real-world comprehensive outcomes, case volume changes, economic impacts, and readmission rates at diverse healthcare centers with and without cSoS remain poorly understood. Methods Consecutive patients undergoing non-PPCI at 47 hospitals (33 cSoS and 14 non-cSoS) in Michigan from April 2016 to March 2018 were included. Using propensity-matching, patients were analyzed to assess outcomes and trends in non-PPCI performance at sites with and without cSOS. Results Of 61,864 PCI's performed, 50,817 were non-PPCI, with 46,096 (90.7%) performed at sites with cSoS and 4,721 (9.3%) at sites without cSoS. From this cohort, 4,643 propensitymatched patients were analyzed. Rates of major adverse cardiac events (2.6% vs. 2.8%; p = 0.443), in-hospital mortality (0.6% vs. 0.5%; p = 0.465), and several secondary clinical and quality outcomes showed no clinically significant differences. Among a small subset with available post-discharge data, there were no differences in 90-day readmission rates, standardized episode costs, or post-discharge mortality. Overall PCI volume remained stable, with a near threefold rise in non-PPCI at sites without cSoS.

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Section: Plos Onementioning

confidence: 76%

Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…The number of off-site PCI centres has increased, and these centres are regarded as safe when compared with on-site PCI centres [ 11 , 12 , 20 , 21 ]. In the UK, emergency cardiac surgery after off-site PCI occurs in <0.1% of patients [ 12 ]. Time delay in STEMI patients significantly decreased at two individual Dutch hospitals after they started offering off-site PCI [ 13 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, during the last 10-15 years, the procedure has been expanded to include hospitals without on-site cardiac surgery (off-site PCI). Expansion of off-site PCI centres ensures timely revascularisation in STEMI patients living in remote areas, which was observed in the United States and the United Kingdom (UK) [9][10][11][12]. In the Netherlands, the first off-site primary PCI centre was established in 2003 [13].…”

Section: What's New?mentioning

confidence: 99%

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Expansion of off-site percutaneous coronary intervention centres significantly reduces ambulance driving time to primary PCI in the Netherlands

et al. 2020

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Introduction In patients with ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI)-mediated reperfusion is preferred over pharmacoinvasive reperfusion with fibrinolysis if transfer to a PCI centre can be ensured in ≤120 min. We evaluated the ambulance driving time to primary PCI centres in the Netherlands and assessed to what extent ambulance driving times were impacted by the expansion of off-site PCI centres. Methods and results We calculated the driving routes from every Dutch postal code to the nearest PCI centre with (on-site) or without (off-site) surgical back-up. We used data from ambulance records to estimate the ambulance driving time on each route. There were 16 on-site and 14 off-site PCI centres. The median (interquartile range) time to on-site PCI centres was 18.8 min (12.2–26.3) compared with 14.9 min (8.9–20.9) to any PCI centre (p < 0.001). In postal code areas that were impacted by the initiation of off-site PCI, the median driving time decreased from 25.4 (18.2–33.1) to 14.7 min (8.9–20.9) (p < 0.001). Ambulance driving times of >120 min were only seen in non-mainland areas. Conclusion Based on a computational model, timely ambulance transfer to a PCI centre within 120 min is available to almost all STEMI patients in the Netherlands. Expansion of off-site PCI has significantly reduced the driving time to PCI centres.

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“…[9,17] A study in United Kingdom had reported the favour of off-site surgical cover in terms of 30-day mortality (HR: 0.87; 95% CI: 0.71 -1.06; p= 0.16) and at 1 year mortality (HR: 0.92; 95% CI: 0.71 -1.06; p= 0.26) in patients with any indication, but lacked statistical significance. [18] Similarly, a report from National Cardiovascular Data Registry had stated observance of similar procedure's success, morbidity, emergency cardiac surgery rates and mortality in PCI centres without on-site surgical backup and in cases that required emergency surgery. [19] In a meta-analysis, Simard T et al had observed that primary PCI as well as elective PCI could be performed safely at PCI centres without on-site surgical backup, without an increase in mortality rates or other complications.…”

Section: Discussionmentioning

confidence: 99%

One-Year Clinical Outcomes in Indian Patients Undergoing Primary Percutaneous Coronary Intervention Without on-Site Surgical Backup

Neeraakal¹,

Gopinathan²

2018

jemds

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BACKGROUND Primary Percutaneous Coronary Intervention (PCI) has emerged as a relatively safe treatment option for acute ST elevation myocardial infarction. However, performing primary PCI at centres without surgical backup has been controversial. To the best of our knowledge, no such data has been available that represents outcomes in Indian population. Thus, this study aims to present one year clinical outcomes in Indian patients undergoing primary PCI without on-site surgical backup. MATERIALS AND METHODS This was a retrospective, single centre, observational study. The study population included 192 patients, who underwent primary PCI from February 2014 to July 2015. The primary endpoint was rate of Major Adverse Cardiac Events (MACE), an agglomerate of cardiac death, myocardial infarction and Target Vessel Revascularisation (TLR) at one year after procedure. RESULTS The mean age of population was 57.2 years where 86.5% were males, 35.4% were diabetics and 22.4% were hypertensives. There were six cardiac deaths at 30-day follow-up and 6 (3.1%) cardiac deaths and 4 (2.1%) events of TLR at one-year follow-up. CONCLUSION In light of these results, it can be concluded that primary PCI can be performed safely at PCI centres without on-site surgical backup, especially in developing countries like India.

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Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom

Abstract: PCI performed at centers without onsite surgical backup is not associated with any mortality hazard.

Cited by 24 publications

References 16 publications

Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience

Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience

Expansion of off-site percutaneous coronary intervention centres significantly reduces ambulance driving time to primary PCI in the Netherlands

One-Year Clinical Outcomes in Indian Patients Undergoing Primary Percutaneous Coronary Intervention Without on-Site Surgical Backup

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