PCI-CAMPOS: PCI Outcomes in Hospitals With and Without Onsite Cardiac Surgery
In 2011, the ACC /American Heart Association/The Society for Cardiovascular Angiography and Intervention-based guidelines for primary and elective percutaneous coronary intervention (PCI) at hospitals without onsite cardiac surgery were expanded to Classes lla and llb respectively. In an effort to evaluate the introduction of PCI care at hospitals without onsite cardiac surgery, the state of California instituted a pilot program comparing PCI results in six pilot and 120 non-pilot facilities. The results of the study were released March 29 as part of ACC.14 in Washington, DC.
Between July 2011 and July 2013 a total of 3,773 patient procedures were performed with 5,155 PCIs in the pilot hospitals while 150,177 procedures were performed with 208,796 PCIs in the non-pilot hospitals. Constructing risk models for PCI composite outcomes using bivariate and multivariate analyses, risk-adjusted safety endpoints (death, stroke, emergency surgery, and composite) and efficacy endpoints (<20 percent residual stenosis, TIMI-3 flow, and composite) were compared for total and STEMI-excluded PCIs from pilot and non-pilot hospitals.
The study ultimately concluded that while pilot without onsite cardiac surgery hospitals performed proportionately more primary PCIs (32 percent) than onsite hospitals (17.9 percent), and showed a significantly better PCI composite safety endpoint (1.87 percent versus 2.36 percent), the pilot without onsite cardiac surgery hospitals had worse composite efficacy endpoints (88.4 percent) than non-pilot hospitals (91 percent).
Based on the data at hand, pilot hospitals without onsite cardiac surgery may offer slightly safer PCI procedures, but with less successful results.
Keywords: Risk, Stroke, Multivariate Analysis, Cardiac Surgical Procedures, Percutaneous Coronary Intervention
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