Angioplasty at hospitals without on-site cardiac surgery safe, effective
Non-emergency angioplasty performed at hospitals without on-site cardiac surgery capability is no less safe and effective than angioplasty performed at hospitals with cardiac surgery services, according to research presented today at the American College of Cardiology's 62nd Annual Scientific Session.
Emergency surgery has become an increasingly rare event following percutaneous coronary intervention (PCI) or angioplasty—a non-surgical procedure used to open narrow or blocked coronary arteries and restore blood flow to the heart. This study adds to the growing body of evidence supporting favorable outcomes for patients undergoing elective or non-emergency angioplasty at hospitals without cardiac surgery on-site. Researchers say there are several reasons why expansion of non-emergency PCI to hospitals without cardiac surgery programs may be viewed favorably.
"Among them are patient choice and patient and physician convenience afforded by providing the ability to remain in a local and familiar community. In addition, the added volume of PCI procedures at these hospitals could help to provide resources to support active primary PCI programs," said Alice Jacobs, MD, professor of medicine at Boston University School of Medicine, and the study's lead investigator. "However, controversy continues to exist surrounding this expansion of services to treat patients in non-emergency settings, where timely access to angioplasty is less important to cardiovascular outcomes and the risk to benefit ratio may differ from the emergency setting."
Dr. Jacobs and her team conducted a prospective, randomized trial comparing the safety and effectiveness of non-emergency angioplasty at 10 hospitals in Massachusetts without on-site cardiac surgery services and seven hospitals with on-site cardiac surgery services. A total of 3,691 patients were randomly assigned in a 3:1 ratio to undergo angioplasty: 2,774 at hospitals without on-site cardiac surgery and 917 at hospitals with surgical backup. The mean age of study subjects was 64 years, 32 percent were women, 32 percent had diabetes and 61 percent presented with an acute coronary syndrome.
Rates of major adverse cardiac events, including death, heart attack, repeat angioplasty and stroke, were assessed at 30 days and 12 months post-angioplasty. Rates at 30 days were 9.5 percent for sites without on-site cardiac surgery compared to 9.4 percent for those with surgical services. Outcomes did not differ significantly between the non-surgical and surgical groups for all-cause mortality, heart attack, repeat angioplasty or stroke. At the 12-month follow up, major adverse cardiac events rates were 17.3 percent for sites without on-site surgery compared to 17.8 percent for sites with surgical services available, and rates of mortality, heart attack, repeat angioplasty and stroke did not differ between groups.
A random sample of 376 study subjects was selected to monitor clinical practice patterns between hospitals with and without cardiac surgery on-site. There were no significant differences between the two treatment groups with respect to procedure success rates, completeness of angioplasty or the proportion of lesions classified as meeting ACCF/AHA/SCAI PCI guidelines Class I or II recommendations for anatomic indications to perform PCI.
"While we did not directly compare all PCI procedures at hospitals with and without cardiac surgery, our results suggest that performance of angioplasty in hospitals without cardiac surgery but with the appropriate experience, established angioplasty programs and the required hospital and operator volume, is an acceptable option for patients presenting to these hospitals for care," Dr. Jacobs said.
More information: This study will be simultaneously published online in the New England Journal of Medicine at the time of presentation.
Journal reference: New England Journal of Medicine
Provided by American College of Cardiology
- Non-emergency angioplasty costs higher in hospitals without back-up surgery Nov 05, 2012 | not rated yet | 0
- Community hospitals can safely perform elective angioplasty Mar 26, 2012 | not rated yet | 0
- Patients fare just as well if their nonemergency angioplasty is performed at hospitals Nov 14, 2011 | not rated yet | 0
- Hospitals without on-site cardiac surgery can perform non-emergency angioplasty safely and effectively Mar 26, 2012 | not rated yet | 0
- Safety in numbers for community hospitals performing emergency angioplasty Nov 13, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Solvability of a circuit
3 hours ago Let's say I have a circuit consisting only of a finite number of batteries and resistors, all ideal. Given an arbitrary shape of this circuit, will I...
Question about perception of colors around light sources
7 hours ago When I look at a distant light source (like car headlights, or street lamp lights) I notice colors of the visible spectrum (as separated (as in after...
Does a charged particle rotate when traveling through a static Bf?
9 hours ago I have been looking at mass spectrometers, in particular the interactions between the Bf ind of a charged particle in motion in a static Bf of the...
Find a link between physics and assignment problems
10 hours ago Hi ! I've been working about assignments problems and how to solve them. I will have to do a presentation about it in few weeks. However, I'll...
Light as a source of electricity
10 hours ago Hello Dear Fellows! We all know that light is an electromagnetic wave and also we know that an antenna receives EM waves and...
A question about the energy stored in a capacitor.
10 hours ago If we imagine a simple circuit with a battery and a capacitor with negligible internal resistance, the capacitor is charged up to a point where the...
- More from Physics Forums - Classical Physics
More news stories
(HealthDay)—Blood levels of free fatty acids are associated with insulin resistance during young adulthood and cardiovascular risk factors in later adulthood, according to a study published online May 13 ...
Cardiology May 17, 2013 | not rated yet | 0 |
An experimental, inexpensive iPhone application transmitted diagnostic heart images faster and more reliably than emailing photo images, according to a research study presented at the American Heart Association's Quality ...
Cardiology May 17, 2013 | not rated yet | 0
Extracorporeal membrane oxygenation (ECMO), a procedure traditionally used during cardiac surgeries and in the ICU that functions as an artificial replacement for a patient's heart and lungs, has also been used to resuscitate ...
Cardiology May 17, 2013 | not rated yet | 0
Age has little to do with how patients should be treated after suffering a stroke, according to new research from the University of Georgia.
Cardiology May 17, 2013 | not rated yet | 0 |
Depressed middle-aged women have almost double the risk of having a stroke, according to research published in Stroke: Journal of the American Heart Association.
Cardiology May 16, 2013 | not rated yet | 0
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
9 hours ago | not rated yet | 0 |
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
10 hours ago | 5 / 5 (2) | 0 |
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
10 hours ago | 4.8 / 5 (4) | 0 |
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
9 hours ago | 5 / 5 (2) | 0 |
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
14 hours ago | not rated yet | 0
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...
9 hours ago | not rated yet | 0