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No major differences in procedural success, mortality in PCI centers without on-site cardiac surgery

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Institutions that performed percutaneous coronary intervention with no on-site cardiac surgery had procedural success and mortality similar to institutions with on-site cardiac surgery.

The analysis cohort consisted of 308,161 patients from the National Cardiovascular Data Registry (NCDR) CathPCI Registry entered between January 2004 and March 2006. Of those, 8,736 patients underwent PCI at 60 institutions with no on-site surgical back-up, with the remaining 299,425 patients undergoing PCI at 405 institutions with surgical back-up. The analysis endpoints were incidence of emergency surgery and in-hospital death from all causes following PCI.

The results, published in yesterday's Journal of the American College of Cardiology, suggested that off-site facilities had a marginally higher aggregate procedural success rate (94% vs. 93%, P=.010). Aggregate total complication rates were also similar for off-site vs. on-site facilities (6.5% vs. 6.3%), although off-site facilities reported more bleeding events while on-site facilities reported more vascular complications. Off-site facilities reported fewer total complications in primary PCI compared with on-site facilities (11.6% vs. 13.4%, P=.029), along with lower general (2.6% vs. 3.3%, P=.001) and vascular (0.8% vs. 1.1%, P=.017) complication rates in nonprimary PCI vs. on-site facilities. There were no differences in risk-adjusted mortality between on-site and off-site facilities, and there were higher risk-adjusted odds of emergency surgery in the on-site facilities (OR=0.60; 95% CI, 0.37-0.98).

Although the results suggested comparability between the two types of facilities, the researchers cautioned against radically altering practice based on the findings.

“These findings should not be extrapolated to encourage the widespread proliferation of more PCI programs without surgery on-site to fulfill a political or economic agenda,” the researchers concluded. “Rather, our study does confirm the safety of an off-site strategy at PCI centers where rigorous clinical, operator and institutional criteria are in place and where data are submitted and reviewed in a comprehensive, multicenter registry such as the NCDR.”

In 2007, Cardiology Today reported that the Society for Cardiovascular Angiography and Interventions released a consensus document on PCI at facilities without onsite surgery, but Gregory J. Dehmer, MD, SCAI president and chair of the panel that created the document, said SCAI does not encourage off-site PCI, but rather wanted to provide guidance for the widely practiced option.

For more information:

• Kutcher MA. J Am Coll Cardiol. 2009;54:16-24.