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Mortality not higher after PCI performed at centers without onsite surgical backup
Patients who underwent PCI at centers in the United Kingdom with and without surgical support had similar rates of survival, researchers reported in a new study.
The researchers performed a retrospective analysis of data from the British Cardiovascular Intervention Society database collected from 2006 to 2012. The database contains information on more than 700,000 patients who had PCI procedures in the United Kingdom.
The current analysis focused on 384,013 patients treated from 2006 to 2012 with a median follow-up of 3.4 years.
The primary endpoint was all-cause mortality at 30 days. Mortality at 1 year and 5 years were secondary endpoints.
Overall, 31% (n = 119,096) of the total cohort underwent PCI at U.K. centers where cardiothoracic surgery was unavailable at the same hospital site or within the same institution.
The crude mortality rate was 2% for patients treated at centers with offsite surgical support vs. 2.2% at centers with onsite surgical support (P < .001), according to results of an unadjusted analysis. After adjustment, the researchers reported no significant differences in survival. At 30 days, mortality was 0.2% lower at offsite surgical centers; at 5 years, mortality was 1.2% lower compared with onsite surgical centers.
The absolute difference in unadjusted mortality at 30 days was similar between offsite and onsite surgical centers was 0.1% for patients with stable angina, 0.1% for patients with non-STEMI and 1.4% for patients with STEMI.
Alice K. Jacobs
“PCI performed at centers without onsite surgical backup is not associated with any mortality hazard,” Scot Garg, MBChB, PhD, of East Lancashire Hospitals NHS Trust, and colleagues concluded.
Despite the nonrandomized study design, the results of this study have value, Ashvin N. Pande, MD, and Alice K. Jacobs, MD, from the department of medicine, section of cardiology, Boston University Medical Center, wrote in an editorial published in the Journal of the American College of Cardiology.
“These data add to a growing body of evidence that suggests that PCI procedures performed at facilities without vs. those with onsite cardiac surgery are comparable in safety,” they wrote.
However, Pande and Jacobs noted several concerns, including results limited to mortality and the failure to include metrics of PCI performance such as operator certification and quality management.
“Gathering evidence has leaned opinion in the cardiovascular community toward expansion of PCI to facilities without onsite cardiac surgery, but we must take steps to ensure that this occurs in the context of appropriate standards and program development to best serve and protect our patients,” Pande and Jacobs wrote. – by Rob Volansky
Disclosure: The researchers, Jacobs and Pande report no relevant financial disclosures.