In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup
- 100 Downloads
Guidelines recommend on-site surgery backup (SB) when elective percutaneous coronary intervention (PCI) is performed. The evidence for this recommendation is however weak.
The objective of the present study was to compare clinical outcomes in patients undergoing PCI in hospitals with SB or without surgery backup (non-SB).
Prospective German PCI registry in 36 hospitals throughout Germany. Consecutive procedures were collected and analyzed centrally.
In 2006, a total of 23,148 patients were included; 12,465 patients (53.8%) in 11 hospitals with SB and 10,683 patients (46.2%) in 25 hospitals without on-site cardiac SB. Both patient groups were well-balanced with regard to age and gender. SB hospitals had more patients with ACS (OR 1.29; 95%CI 1.23–1.36) and less patients with stable angina (OR 0.78; 95%CI 0.74–0.82) than non-SB hospitals. There was no indication of a clinically relevant differential outcome for in-hospital death, MACE, non-fatal MI, non-fatal stroke/TIA, or emergency CABG between SB and non-SB hospitals for neither patients with ACS nor stable angina except for emergency CABG in ACS patients (more frequent in SB hospitals, OR 2.29; 95%CI 1.02–5.13).
There was no evidence of an excess risk associated with PCI-procedures performed in non-SB hospitals.
KeywordsPCI Surgery backup Outcome MACE Mortality
- 1.Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SBIII, Morrison DA, O’Neill WW et al (2006) ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 113:156–175CrossRefPubMedGoogle Scholar
- 3.Koeth O, Bauer T, Wienbergen H, Gitt AK, Juenger C, Zeymer U, Hauptmann KE, Glunz HG et al (2009) Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry. Clin Res Cardiol 98:107–113CrossRefPubMedGoogle Scholar
- 10.Richardson SG, Morton P, Murtagh JG, O’Keeffe DB, Murphy P, Scott ME (1990) Management of acute coronary occlusion during percutaneous transluminal coronary angioplasty: experience of complications in a hospital without on site facilities for cardiac surgery. BMJ 300:355–358CrossRefPubMedGoogle Scholar
- 21.Zeymer U, Zahn R, Hochadel M, Bonzel T, Weber M, Gottwik M, Tebbe U, Senges J (2005) Indications and complications of invasive diagnostic procedures and percutaneous coronary interventions in the year 2003. Results of the quality control registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Z Kardiol 94:392–398CrossRefPubMedGoogle Scholar
- 25.Dehmer GJ, Blankenship J, Wharton TP Jr, Seth A, Morrison DA, Dimario C, Muller D, Kellett M et al (2007) The current status and future direction of percutaneous coronary intervention without on-site surgical backup: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 69:471–478CrossRefPubMedGoogle Scholar
- 26.Kutcher MA, Klein LW, Ou FS, Wharton TP Jr, Dehmer GJ, Singh M, Anderson HV, Rumsfeld JS et al (2009) Percutaneous coronary interventions in facilities without cardiac surgery on site: a report from the National Cardiovascular Data Registry (NCDR). J Am Coll Cardiol 54:16–24CrossRefPubMedGoogle Scholar
- 31.Moscucci M, Share D, Smith D, O’Donnell MJ, Riba A, McNamara R, Lalonde T, Defranco AC et al (2005) Relationship between operator volume and adverse outcome in contemporary percutaneous coronary intervention practice: an analysis of a quality-controlled multicenter percutaneous coronary intervention clinical database. J Am Coll Cardiol 46:625–632CrossRefPubMedGoogle Scholar
- 32.Zahn R, Gottwik M, Hochadel M, Zeymer U, Vogt A, Meinertz T, Dietz R, Hauptmann KE et al (2008) Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Heart 94:329–335CrossRefPubMedGoogle Scholar