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CPORT-E: On-Site Cardiac Surgery Capability Did Not Influence Elective Angioplasty Results
Aversano T. LBCT 02. Presented at: the American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
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ORLANDO, Fla. — Researchers of a late-breaking clinical trial have reported that patients undergoing non-emergency angioplasty in hospitals without on-site cardiac surgery had similar outcomes vs. patients who underwent angioplasty in hospitals with cardiac surgery capability.
For the CPORT-E trial, investigators randomly assigned nearly 14,000 patients to have their procedure performed at a hospital with cardiac surgery capabilities and 4,500 patients at hospitals without.
Investigators calculated a 6-week mortality rate of 0.91% for patients who underwent elective angioplasty at a hospital with no on-site cardiac surgery vs. 0.93% at hospitals without on-site cardiology (P=.94). Emergency surgery was required for 0.1% of patients who underwent procedures at hospitals without on-site surgery vs. 0.2% of patients from hospitals with on-site cardiac surgery.
According to data presented by Thomas Aversano, MD, associate professor of medicine at Johns Hopkins Medicine Heart and Vascular Institute, at a press conference, there were no significant differences in the incidence of other major adverse events, including stroke, bleeding, renal failure and the need for vascular repair in patients treated at hospitals with or without cardiac surgery on-site.
“In hospitals without on-site cardiac surgery that complete a formal PCI development program, adhere to C-PORT participation requirements and whose outcomes are monitored, non-primary PCI is safe and associated with similar rates of adverse events, including mortality,” Aversano said.
During the press conference, Robert Harrington, MD, director of the Duke Clinical Research Institute, Durham, N.C., said longer-term follow-up on mortality and economic implications are required to determine the safety of procedures performed at hospitals without on-site cardiac surgery capabilities. “We need to better understand the subset of patients who needed emergency procedures, either PCI or CABG, [and] give some thought to the notion of what happens as you expand centers with a fixed amount of cardiac volume,” he said. – by Casey Murphy
Disclosure: Dr. Aversano has received funding from participating hospitals; Dr. Harrington reports no relevant financial disclosures.