Elective PCI in Ambulatory Surgery Centers

Nov 09, 2020
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Authors:
Li K, Kalwani NM, Heidenreich PA, Fearon WF.
Citation:
Elective Percutaneous Coronary Intervention in Ambulatory Surgery Centers. JACC Cardiovasc Interv 2020;Nov 9:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • There was no difference between propensity-matched ambulatory surgery center (ASC) and hospital outpatient department PCI in the primary composite outcome of MI, bleeding complications, or hospital admission.
  • However, there was an increased odds of post-procedural bleeding complications in the ASC-treated group after controlling for covariables.
  • There is a need for better or improved pre-procedural risk stratification prior to treating patients in the ASC setting to optimize outcomes.

Study Questions:

What are the characteristics and outcomes of patients undergoing elective percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs)?

Methods:

The investigators studied adults who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease from 2007-2016 using commercial insurance claims from MarketScan. The authors used propensity score analysis to measure the association between treatment setting and the primary composite outcome of 30-day myocardial infarction (MI), bleeding complications, and hospital admission.

Results:

The unmatched sample consisted of 95,492 HOPD and 849 ASC PCIs. Patients who underwent ASC PCI were more likely to be <65 years of age, live in the southern United States, and have managed or consumer-driven health insurance. ASC PCI was also associated with decreased fractional flow reserve (FFR) utilization (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.20-0.48; p < 0.001). In unmatched, multivariable analysis, ASC PCI was associated with increased odds of the primary outcome (OR, 1.25; 95% CI, 1.01-1.56; p = 0.039) and bleeding complications (OR, 1.80; 95% CI, 1.11-2.90; p = 0.016). In propensity-matched analysis, ASC PCI was not associated with the primary outcome (OR, 1.23; 95% CI, 0.94-1.60; p = 0.124) though it was significantly associated with increased bleeding complications (OR, 2.49; 95% CI, 1.25-4.95; p = 0.009).

Conclusions:

The authors concluded that commercially insured patients undergoing ASC PCI were less likely to undergo FFR testing and had higher odds of bleeding complications than HOPD-treated patients.

Perspective:

This study did not observe a difference between propensity-matched ASC and HOPD PCI in the primary composite outcome of MI, bleeding complications, or hospital admission. However, there was an increased odds of post-procedural bleeding complications in the ASC-treated group when assessed as an individual outcome after controlling for covariables. This may be related to facility- or operator-level variation across factors such as vascular access site, use of vascular closure devices, and operator volume. Of note, there was decreased utilization of FFR in ASCs, a tool associated with improved long-term outcomes. There is a need for better or improved pre-procedural risk stratification prior to treating patients in the ASC setting to optimize outcomes.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Prevention

Keywords: Ambulatory Surgical Procedures, Fractional Flow Reserve, Myocardial, Hemorrhage, Insurance, Health, Myocardial Infarction, Myocardial Ischemia, Outcome Assessment, Health Care, Outpatients, Percutaneous Coronary Intervention, Risk Assessment, Secondary Prevention, Vascular Closure Devices, AHA20, AHA Annual Scientific Sessions


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