Key result
Non-primary PCI at centers without on-site cardiac surgery was associated with similar rates of major adverse cardiac events compared to surgical sites (2.6% vs. 2.8%; p=0.443).
Why the study?
Real-world comprehensive outcomes, case volume changes, economic impacts, and readmission rates for non-primary PCI at centers with and without on-site cardiac surgery remained poorly understood.
Does non-primary PCI at sites without on-site cardiac surgery have similar outcomes compared to sites with on-site cardiac surgery in patients undergoing non-primary PCI?
Cohort (n=4,643)
Yes
Does non-primary PCI at sites without on-site cardiac surgery have similar outcomes compared to sites with on-site cardiac surgery in patients undergoing non-primary PCI?
Absolute Event Rate: 2.6% vs 2.8%
p-value: p=0.443
Non-primary PCI performed at centers without on-site cardiac surgery is associated with similar clinical outcomes and costs compared to centers with on-site surgery, supporting the safety of this practice with appropriate quality oversight.
Non-primary PCI without on-site surgery was associated with similar outcomes; extends observational data but leaves open need for randomized confirmation.
INTRODUCTION: Non-primary percutaneous coronary intervention (non-PPCI) recently received certificate of need approval in the state of Michigan at sites without cardiac surgery on-site (cSoS). This requires quality oversight through participation in the BMC2 registry. While previous studies have indicated the safety of this practice, real-world comprehensive outcomes, case volume changes, economic impacts, and readmission rates at diverse healthcare centers with and without cSoS remain poorly understood. METHODS: Consecutive patients undergoing non-PPCI at 47 hospitals (33 cSoS and 14 non-cSoS) in Michigan from April 2016 to March 2018 were included. Using propensity-matching, patients were analyzed to assess outcomes and trends in non-PPCI performance at sites with and without cSOS. RESULTS: Of 61,864 PCI's performed, 50,817 were non-PPCI, with 46,096 (90.7%) performed at sites with cSoS and 4,721 (9.3%) at sites without cSoS. From this cohort, 4,643 propensity-matched patients were analyzed. Rates of major adverse cardiac events (2.6% vs. 2.8%; p = 0.443), in-hospital mortality (0.6% vs. 0.5%; p = 0.465), and several secondary clinical and quality outcomes showed no clinically significant differences. Among a small subset with available post-discharge data, there were no differences in 90-day readmission rates, standardized episode costs, or post-discharge mortality. Overall PCI volume remained stable, with a near three-fold rise in non-PPCI at sites without cSoS. CONCLUSIONS: Non-PPCI at centers without cardiac SoS was associated with similar comprehensive outcomes, quality of care, 90-day episode costs, and post-discharge mortality compared with surgical sites. Mandatory quality oversight serves to maintain appropriate equivalent outcomes and may be considered for other programs, including the performance of non-PPCI at ambulatory surgical centers in the near future.
No takes yet. Share an insight, caveat, or question.
Afana et al. (2020) conducted a cohort in Coronary artery disease requiring non-primary percutaneous coronary intervention (n=4,643). Non-primary PCI at sites without cardiac surgery on-site vs. Non-primary PCI at sites with cardiac surgery on-site was evaluated on Major adverse cardiac events (p=0.443). Non-primary PCI at centers without on-site cardiac surgery was associated with similar rates of major adverse cardiac events compared to surgical sites (2.6% vs. 2.8%; p=0.443).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: