BMC2 Registry: PCI safe at hospitals without on-site cardiac surgery

LAS VEGAS — Patients with STEMI treated with PCI had no difference in outcomes regardless of whether they were treated at a hospital with on-site cardiac surgical backup or no on-site cardiac surgical backup, according to new research.

Researchers analyzed 11,920 patients with STEMI treated with PCI enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry. All patients were treated at nonfederal hospitals in Michigan from January 2010 to June 2013.

The researchers compared outcomes for those who were treated at hospitals with on-site cardiac surgical backup (n=9,547) vs. hospitals without on-site cardiac surgical backup (n=2,373). At baseline, the groups did not differ in patient demographics, history and risk factors, severity of illness at presentation and procedure complications.

Jason Weingart

At the Society for Cardiovascular Angiography and Interventions Scientific Sessions, Jason Weingart, MD, reported no significant difference between the two groups in rates of serious procedure-related complications, including stroke, HF, need for kidney dialysis, complications at the arterial puncture site, excessive bleeding or need for CABG.

Patients treated at hospitals without on-site cardiac surgical backup were more likely to be transferred to other acute care hospitals at discharge (10.4% vs. 1%; absolute standard difference, 41.7) and less likely to be referred for cardiac rehabilitation (49.2% vs. 79.4%; absolute standard difference, 49) compared with those patients at hospitals with on-site cardiac surgical backup, according to results presented.

Weingart, from University of Michigan Health System, and colleagues also analyzed Medicare data related to mortality and readmission for 2,243 of the patients. After adjusting for baseline predicted mortality risk, prior HF, PCI status (elective, urgent, emergency or salvage), cardiogenic shock, age, baseline glomerular filtration rate, chronic lung disease, peripheral arterial disease and cardiac arrest, there was no difference between the groups in adjusted in-hospital mortality (OR=0.87; 95% CI, 0.69-1.09), adjusted long-term mortality (HR=1.1; 95% CI, 0.86-1.4) or adjusted 30-day readmission (sites with surgical backup, 19.1%; sites without surgical backup, 20.2%; P=.62).

“These data suggest that primary PCI can be done safely in centers without [on-site cardiac surgical backup] with no significant difference in outcomes including in-hospital mortality, long-term mortality or 30-day hospital readmission rates,” Weingart and colleagues wrote in the study abstract. – by Erik Swain

For more information:

Weingart J. Abstract A-070. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 28-31, 2014; Las Vegas.

Disclosure: Weingart reports no relevant financial disclosures.