Percutaneous Coronary Interventions without On-Site Cardiac Surgical Backup

Shahian, David M.; Meyer, Gregg S.; Yeh, Robert W.; Fifer, Michael A.; Torchiana, David F.

doi:10.1056/nejmra1109616

Cited by 17 publications

(13 citation statements)

References 91 publications

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“…4 Thereafter, improvements in techniques and devices, wide use of more advanced DES, and increasing operator experience were followed by decreasing rates of emergency surgery to 0.14% to 0.37%. 4,24 In addition, because primary PCI has been proven to produce significantly better outcomes than thrombolysis, improved access to primary PCI has become more important. Moreover, increasing evidence supports noninferior clinical outcomes of PCI at centers without on-site surgery, in comparison with centers with on-site surgery.…”

Section: Reappraisal Of the Rationale For On-site Surgerymentioning

confidence: 99%

“…4 The expansion of nonprimary PCI to centers without on-site surgery has advantages and disadvantages. The advantages may include greater hospital choice, greater opportunity to remain close to home, more continuity of care with local physicians, closer postoperative follow-up, and enhanced secondary prevention.…”

Section: Nonprimary or Elective Pci Without On-site Surgerymentioning

confidence: 99%

“…However, these advantages should be balanced with potential disadvantages, such as the incremental risks of life-threatening complications and resultant mortality. 2,4,32 Data about clinical outcomes in centers without on-site surgery have been conflicting. Analysis of Medicare administrative data by Wennberg et al 14 generated concern about the safety of PCI without on-site surgical backup.…”

Section: Nonprimary or Elective Pci Without On-site Surgerymentioning

confidence: 99%

“…Subsequently, numerous studies showed that safety and efficacy of primary PCI are similar in centers with and without on-site surgical capability. 4,5 Current American College of Cardiology Foundation/ American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines recommend that primary PCI for STEMI be performed at centers without on-site surgical backup (class IIa, level of evidence: B). …”

mentioning

confidence: 99%

“…[2][3][4] Despite this progress, concerns remain about performing percutaneous coronary intervention (PCI) at centers without on-site surgical backup, especially regarding nonprimary PCI for conditions other than ST-segment-elevation myocardial infarction (STEMI). Because primary PCI confers longer survival and timely reperfusion, increased access to primary PCI was encouraged.…”

mentioning

confidence: 99%

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Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup

et al. 2015

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T he need for emergency cardiac surgery has decreased dramatically from 6% to 10%, 1 during the era of balloon angioplasty, to 0.1% to 0.4% in the current era of stents because of the many advances in technology, techniques, adjunctive pharmacotherapy, and operator experience. [2][3][4] Despite this progress, concerns remain about performing percutaneous coronary intervention (PCI) at centers without on-site surgical backup, especially regarding nonprimary PCI for conditions other than ST-segment-elevation myocardial infarction (STEMI). Because primary PCI confers longer survival and timely reperfusion, increased access to primary PCI was encouraged. Subsequently, numerous studies showed that safety and efficacy of primary PCI are similar in centers with and without on-site surgical capability. 4,5 Current American College of Cardiology Foundation/ American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines recommend that primary PCI for STEMI be performed at centers without on-site surgical backup (class IIa, level of evidence: B). 1,5 Editorial see p 365 Clinical Perspective on p 401Conversely, nonprimary PCI has been a major issue in this debate; no survival benefit supports allowing nonprimary PCI at centers without on-site surgical backup. Nonprimary Background-Emergency coronary artery bypass grafting for unsuccessful percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate the current safety and outcomes of primary PCI and nonprimary PCI at centers with and without on-site surgical backup. Methods and Results-We performed an updated systematic review and meta-analysis by using mixed-effects models. We included 23 high-quality studies that compared clinical outcomes and complication rates of 1 101 123 patients after PCI at centers with or without on-site surgery. For primary PCI for ST-segment-elevation myocardial infarction (133 574 patients), all-cause mortality (without on-site surgery versus with on-site surgery: observed rates, 4.8% versus 7.2%; pooled odds ratio [OR], 0.99; 95% confidence interval, 0.91-1.07; P=0.729; I 2 =3.4%) or emergency coronary artery bypass grafting rates (observed rates, 1.5% versus 2.4%; pooled OR, 0.76; 95% confidence interval, 0.56-1.01; P=0.062; I 2 =42.5%) did not differ by presence of on-site surgery. For nonprimary PCI (967 549 patients), all-cause mortality (observed rates, 1.6% versus 2.1%; pooled OR, 1.15; 95% confidence interval, 0.94-1.41; P=0.172; I 2 =67.5%) and emergency coronary artery bypass grafting rates (observed rates, 0.5% versus 0.8%; pooled OR, 1.14; 95% confidence interval, 0.62-2.13; P=0.669; I 2 =81.7%) were not significantly different. PCI complication rates (cardiogenic shock, stroke, aortic dissection, tamponade, recurrent infarction) also did not differ by on-site surgical capability. Cumulative meta-analysis of nonprimary PCI showed a temporal decrease of the effect size (OR) for all-cause mortality after 2007. Conclusions-Clinical outcomes and complication rates of PCI at centers without on-...

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Section: Reappraisal Of the Rationale For On-site Surgerymentioning

confidence: 99%

Section: Nonprimary or Elective Pci Without On-site Surgerymentioning

confidence: 99%

Section: Nonprimary or Elective Pci Without On-site Surgerymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup

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ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures

Harold

Bass

Bashore³

et al. 2013

Cathet Cardio Intervent

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Austrian National CathLab Registry (ANCALAR): cardiac catheterization, coronary angiography (CA), and percutaneous coronary intervention (PCI) in Austria during the year 2011 (Registry Data with Audit including 2012)

Mühlberger

Kobel

Kaltenbach

et al. 2013

Wien Klin Wochenschr

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Concerning international comparison for the year 2011, Austria is situated under the top nations with 6,383 diagnostic coronary angiographies (CA), 2,407 percutaneous coronary interventions (PCI), and 47 transarterial aortic valve implantations (TAVI) per 1 million inhabitants in Europe. Although the number of TAVI increases rapidly since its first introduction in 2007 (47 TAVI per 1 million inhabitants in 2011, not including surgical cases from the transapical route), the data for CA and PCI remained constant during the past years.The rates of stent (91%) and drug-eluting stent implantations (78% of stents) also remained constant on a high level. Little fluctuation is also reflected in the complication data (including mortality evaluation). An increased morality is well known, especially in patients with the so-called ST-segment elevation myocardial infarction and consecutive shock (19-35% in the past years).The application of certain special devices increased (clot catcher) or decreased (glycoprotein IIb/IIIa receptor antagonist) in 2011 or were finally unused (Laser).Interestingly, not only in Austria, it was observed several times that scientific knowledge, recommended as Class I Indications in the guidelines, takes several years to establish itself nationwide.Our independent, purely academic activity is located in the area of health services research, and has also the option to generate benchmarks for individual centers. Participation in our surveys is voluntary. Since 1992, every year, without interruption (no missing center!), 90-100 parameters are applicable. The questionnaire will be optimized and adapted to current conditions. This is done in cooperation with the participating centers. To provide comparability, we make only minimal and absolutely most necessary modifications.The data are collected and summarized at the end of the year by each center itself. During the year, the centers are visited to perform audits and to keep personal contact to them.The data for 2011 were presented in Linz (November 23, 2012) at the autumn meeting of the working group "Interventional Cardiology of the Austrian Society of Cardiology" (ÖKG), as a basis for discussion. The presentation can be viewed by using private access code to the ÖKG video presentation page ( http://oekg.medroom.at/ ); the publication will also be placed under the website http://iik.i-med.ac.at.

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Percutaneous Coronary Interventions without On-Site Cardiac Surgical Backup

Cited by 17 publications

References 91 publications

Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup

Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup

ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures

Austrian National CathLab Registry (ANCALAR): cardiac catheterization, coronary angiography (CA), and percutaneous coronary intervention (PCI) in Austria during the year 2011 (Registry Data with Audit including 2012)

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