What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Percutaneous coronary intervention (primary and nonprimary) (n=1101123). Intervention: PCI at centers without on-site surgical backup vs. PCI at centers with on-site surgical backup. Primary outcome: All-cause mortality for primary PCI (OR 0.99, 95% CI 0.91-1.07, p=0.729).

What does this research mean for the field?

Clinical outcomes, complication rates, and all-cause mortality for both primary and nonprimary PCI do not significantly differ between centers with and without on-site surgical backup. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the clinical outcomes, mortality, and complication rates of primary and nonprimary percutaneous coronary intervention performed at centers with versus without on-site cardiac surgical backup.

August 19, 2026CirculationOpen Access

Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup

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Key result

Primary PCI without on-site surgical backup shows no mortality difference versus on-site surgery centers.

OR 0.99
95% CI 0.91-1.07
P=0.729
n=1,101,123

Why the study?

Emergency coronary artery bypass grafting for unsuccessful PCI is now rare, prompting an evaluation of the current safety and outcomes of primary and nonprimary PCI at centers with versus without on-site surgical backup.

Does performing PCI at centers without on-site surgical backup worsen clinical outcomes compared to centers with on-site surgery in patients undergoing primary or nonprimary PCI?

Population

1 101 123 patients after PCI across 23 high-quality studies

Comparison

PCI at centers without on-site surgery vs with on-site surgery

Design

Systematic review and meta-analysis using mixed-effects models

Authors

JLJoo Myung LeeInterventional / Structural Cardiology DHDoyeon HwangInterventional Cardiology JPJonghanne ParkRutgers, The State University of New Jersey

Discussion

Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

AS Arnold SetoInterventional cardiologist, VA Long Beach Healthcare System

“There's been increasing data, both from randomized trials—CPORT and MASS COMM—as well as the observational data, that suggest that the rate of emergency CABG has declined from what it used to be back in the 1980s, from as high as 25% to where it's now 0.1%”

VA Long Beach Healthcare SystemNews Coverage

CLCindy L. GrinesInterventional cardiologist, Northside Hospital Cardiovascular Institute

“We are liberalizing the 2014 criteria. We are allowing centers to perform more complex PCI cases. It does not matter which cath lab you look at — patients are older, have more calcified lesions and more diffuse disease. Despite those comorbidities, patients do well regardless of where they are treated. That said, we do not want everyone to perform these procedures without surgical backup unless they are very experienced. We cannot emphasize that enough.”

Northside Hospital Cardiovascular InstituteNews Coverage

CLCindy L. GrinesInterventional cardiologist, Northside Hospital Cardiovascular Institute

“given the change in practice patterns, as well as the change in reports showing good outcomes, we felt an update was warranted”

Northside Hospital Cardiovascular InstituteNews Coverage

Implication

PCI without on-site surgery yields equivalent outcomes; reinforces consensus on safety for primary and nonprimary PCI.

Key Points

To evaluate the clinical outcomes, mortality, and complication rates of primary and nonprimary percutaneous coronary intervention performed at centers with versus without on-site cardiac surgical backup.
Conducted a systematic review and meta-analysis of 23 high-quality studies including 1,101,123 patients undergoing PCI at centers with or without on-site surgery.
Used mixed-effects models and cumulative meta-analysis to evaluate all-cause mortality, emergency coronary artery bypass grafting rates, and procedural complications.
For primary PCI (N=133,574), all-cause mortality was 4.8% without on-site surgery vs 7.2% with on-site surgery (pooled OR 0.99; 95% CI, 0.91–1.07; P=0.729), and emergency CABG rates were 1.5% vs 2.4% (pooled OR 0.76; 95% CI, 0.56–1.01; P=0.062).
For nonprimary PCI (N=967,549), all-cause mortality was 1.6% without on-site surgery vs 2.1% with on-site surgery (pooled OR 1.15; 95% CI, 0.94–1.41; P=0.172), and emergency CABG rates were 0.5% vs 0.8% (pooled OR 1.14; 95% CI, 0.62–2.13; P=0.669).
Complication rates including cardiogenic shock, stroke, aortic dissection, tamponade, and recurrent infarction showed no differences, with cumulative meta-analysis revealing a temporal decline in nonprimary PCI mortality odds ratios after 2007.

Study Design

Type

Meta-Analysis (n=1,101,123)

Multicenter

Yes

Structured PICO

Does performing PCI at centers without on-site surgical backup worsen clinical outcomes compared to centers with on-site surgery in patients undergoing primary or nonprimary PCI?

Population

1,101,123 patients undergoing primary or nonprimary percutaneous coronary intervention at centers with or without on-site surgical backup.

Exposure

Percutaneous coronary intervention (PCI) performed at centers without on-site surgical backup

Comparator

Percutaneous coronary intervention (PCI) performed at centers with on-site surgical backup

Outcome

All-cause mortality and emergency coronary artery bypass grafting rateshard clinical

Main Result

Odds Ratio: 0.99 (95% CI 0.91–1.07)

Absolute Event Rate: 4.8% vs 7.2%

p-value: p=0.729

PCI can be performed safely at centers without on-site surgical backup for both primary and nonprimary indications, with no significant difference in mortality or emergency CABG rates compared to centers with on-site surgery.

Cite This Study

Lee et al. (2015) conducted a meta-analysis in Percutaneous coronary intervention (primary and nonprimary) (n=1,101,123). PCI at centers without on-site surgical backup vs. PCI at centers with on-site surgical backup was evaluated on All-cause mortality for primary PCI (OR 0.99, 95% CI 0.91-1.07, p=0.729). PCI at centers without on-site surgical backup showed no significant difference in all-cause mortality compared to centers with on-site surgery for primary PCI (OR 0.99; 95% CI 0.91-1.07; P=0.729).

synapsesocial.com/papers/6a85750754da1e76a74cb10b https://doi.org/10.1161/circulationaha.115.016137

Topics

Percutaneous coronary intervention Coronary artery disease Chronic total occlusion PCI

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Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup

Discussion

Member takes

Key expert perspectives

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup

Discussion

Member takes

Key expert perspectives

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider