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PCI in Offsite vs. Onsite Surgical Centers
Study Questions:
What are the outcomes of percutaneous coronary intervention (PCI) performed in centers with and without surgical support?
Methods:
The investigators performed a retrospective analysis of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed in centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years.
Results:
Outcomes at a median of 3.4 years of follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated in offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated in centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%, p < 0.001). Following multivariable adjustment, there were no between-group differences in survival amongst the naive and imputed populations at 30 days (naive population hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.71-1.06; p = 0.16 and imputed population HR, 0.99; 95% CI, 0.89-1.09; p = 0.82); 1 year (HR, 0.92; 95% CI, 0.79-1.07; p = 0.26 and HR, 0.99; 95% CI, 0.92-1.06; p = 0.78); or 5 years (HR, 0.92; 95% CI, 0.84-1.01; p = 0.10 and HR, 0.97; 95% CI, 0.92-1.03; p = 0.29). Results were consistent irrespective of procedural indication. No differences in mortality were seen in sensitivity analyses performed using a propensity-matched population of 74,001 patients.
Conclusions:
The authors concluded that PCI performed in centers without onsite surgical backup is not associated with any mortality hazard.
Perspective:
This retrospective analysis reports that there is no association between survival and whether or not PCI is performed in a center with onsite surgical support, likely attributable to the dramatic drop in need for emergency coronary artery bypass surgery after PCI in recent years. Additional data from registries in other countries in which a high proportion of PCI procedures are performed without onsite surgical support will help provide more insight and help in selection of patients who benefit from procedures performed at centers where onsite surgical backup is not available.
Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Patient Outcome Assessment, Percutaneous Coronary Intervention
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