March 11, 2013New England Journal of Medicine
Nonemergency PCI at Hospitals with or without On-Site Cardiac Surgery
Why the study?
Does performing nonemergency PCI at hospitals without on-site cardiac surgery result in noninferior outcomes compared to hospitals with on-site cardiac surgery in patients requiring nonemergency PCI?
Population
3,691 patients with indications for nonemergency PCI presenting at hospitals in Massachusetts without…
Comparison
Nonemergency PCI performed at a hospital without… vs Nonemergency PCI performed at a partner hospital…
Design
RCT, randomly assigned in a 3:1 ratio
Follow-up
12 months
Authors
Discussion
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Member takes
Implication
Nonemergency PCI meets noninferiority without on-site surgery; confirms safety and supports expanded community hospital programs.
Structured PICO
Does performing nonemergency PCI at hospitals without on-site cardiac surgery result in noninferior outcomes compared to hospitals with on-site cardiac surgery in patients requiring nonemergency PCI?
P
Population
3,691 patients with indications for nonemergency PCI presenting at hospitals in Massachusetts without on-site cardiac surgery.
I
Intervention
Nonemergency PCI performed at a hospital without on-site cardiac surgery
C
Comparator
Nonemergency PCI performed at a partner hospital with on-site cardiac surgery
O
Outcome
Coprimary end points: rates of major adverse cardiac events (composite of death, myocardial infarction, repeat revascularization, or stroke) at 30 days (safety end point) and at 12 months (effectiveness end point)composite
Nonemergency PCI can be safely performed at hospitals without on-site cardiac surgery, with clinical outcomes noninferior to those at hospitals with on-site surgical backup.
Cite This Study
Jacobs et al. (2013) studied this question.