Key result
Percutaneous coronary intervention in hospitals without on-site cardiac surgery backup showed no significant differences in mortality, stroke, or emergency CABG compared to hospitals with backup.
Why the study?
Does performing PCI in hospitals without on-site cardiac surgery backup increase mortality, stroke, or emergency CABG compared to hospitals with backup in patients undergoing PCI?
Observational (n=34,363)
Yes
Does performing PCI in hospitals without on-site cardiac surgery backup increase mortality, stroke, or emergency CABG compared to hospitals with backup in patients undergoing PCI?
PCI can be safely performed in hospitals without on-site cardiac surgery backup, with no significant difference in mortality or emergency CABG compared to hospitals with on-site surgery.
Supports PCI without on-site surgery backup; leaves open need for randomized confirmation before practice change.
OBJECTIVE: To compare characteristics and outcome of patients undergoing percutaneous coronary intervention (PCI) in clinics with (WSB) or without (NOSB) on-site cardiac surgery backup. DESIGN: Analysis according to hospital, type of prospectively collected data of all patients who underwent PCI during 2000-3. SETTING: The Swedish Coronary Angiography and Angioplasty Registry covers all PCI procedures performed in Sweden. PATIENTS: 34,363 patients underwent PCI between January 2000 and December 2003. 8838 procedures were performed in NOSB (mean age of patients was 64.5 years) hospitals and 25,525 in WSB (mean age of patients was 64.1 years) hospitals (p = 0.002). RESULTS: More patients in NOSB hospitals had diabetes (17.8% vs 16.8%; p = 0.03). Other clinical characteristics (previous infarct, previous coronary artery bypass graft (CABG)) also showed a tendency towards worse patients being treated in NOSB hospitals. However, there was a higher percentage of patients with ST-segment elevation myocardial infarction (18% vs 9.7%; p<0.01) in WSB hospitals. After adjusting for differences in baseline risk no significant differences regarding outcome (30-day mortality, 1-year mortality, stroke and emergency CABG) were observable between WSB and NOSB hospitals. This applied to elective and non-elective procedures. CONCLUSIONS: On the basis of these data it does not seem warranted to recommend against percutaneous transluminal coronary angioplasty in NOSB hospitals.
No takes yet. Share an insight, caveat, or question.
James et al. (2006) conducted an observational in Percutaneous coronary intervention (PCI) (n=34,363). PCI in hospitals without on-site cardiac surgery backup (NOSB) vs. PCI in hospitals with on-site cardiac surgery backup (WSB) was evaluated on 30-day mortality, 1-year mortality, stroke and emergency CABG. Percutaneous coronary intervention in hospitals without on-site cardiac surgery backup showed no significant differences in mortality, stroke, or emergency CABG compared to hospitals with backup.
Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context: