Key result
PCI at hospitals with surgical backup showed no significant difference in 30-day mortality (OR 0.91; 95% CI 0.53-1.54) compared to non-surgical facilities, but had higher eCABG and rePCI rates.
Why the study?
Although guidelines suggest PCIs at non-surgical on-site facilities have outcomes comparable to surgical on-site centers, differing perspectives in the literature sustain controversy.
Does performing PCI at non-surgical on-site facilities compared to surgical on-site centers affect clinical outcomes in patients undergoing PCI?
Meta-Analysis (n=2,181,897)
Yes
Does performing PCI at non-surgical on-site facilities compared to surgical on-site centers affect clinical outcomes in patients undergoing PCI?
Odds Ratio: 0.91 (95% CI 0.53–1.54)
PCI performed at non-surgical on-site facilities has comparable rates of mortality, MI, and stroke to surgical on-site centers, supporting current guidelines.
May support PCI without surgical backup given similar mortality; leaves open reasons for higher eCABG/rePCI rates in observational meta-analyses.
Percutaneous coronary interventions (PCIs) have seen a steady rise. Recent guidelines have established that PCIs conducted at non-surgical on-site (NSOS) facilities have low complication rates and outcomes comparable to surgical on-site (SOS) centers. However, differing perspectives in the growing literature continue to sustain controversy. A thorough literature review was performed across four databases, including PubMed, Cochrane Library, Scopus, and Web of Science, to identify studies comparing outcomes between hospitals. The primary endpoints were: 30-day mortality, myocardial infarction (MI), cerebral vascular accident (CVA), emergency coronary artery bypass surgery (eCABG), rePCI, and target vessel revascularization (TVR). The final search yielded 22 studies, including a total of 2,181,897 patients. The majority of patients (71.9%) underwent PCI in SOS hospitals. There was a significant association of increased eCABG (OR = 1.99; 95% CI: 1.08-3.67) and rePCI (OR = 1.62; 95% CI: 1.37-1.91) rates in SOS hospitals. However, 30-day mortality (OR = 0.91; 95% CI: 0.53-1.54), MI (OR = 1.08; 95% CI: 0.91-1.28), CVA (OR = 1.13; 95% CI: 0.69-1.86), and TVR (OR = 1.06; 95% CI: 0.92-1.21) showed no significant difference between hospitals. Subgroup analyses among clinical trials and ST-segment elevation myocardial infarction (STEMI) patients found no significant associations. Conclusively, this meta-analysis provides updated insight into the impact of SOS on PCI outcomes, having no difference except for eCABG and rePCI rates.
No takes yet. Share an insight, caveat, or question.
Haddad et al. (2025) conducted a meta-analysis in Percutaneous coronary interventions (PCI) (n=2,181,897). Surgical on-site (SOS) backup vs. Non-surgical on-site (NSOS) facilities was evaluated on 30-day mortality (OR 0.91, 95% CI 0.53-1.54). PCI at hospitals with surgical backup showed no significant difference in 30-day mortality (OR 0.91; 95% CI 0.53-1.54) compared to non-surgical facilities, but had higher eCABG and rePCI rates.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: