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.

has become an increasingly rare event following percutaneous (PCI) or —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 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 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 but with the appropriate experience, established angioplasty programs and the required 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.

Related Stories

Community hospitals can safely perform elective angioplasty

date Mar 26, 2012

New evidence shows that with appropriate preparation, angioplasty can be safely and effectively performed at community hospitals without on-site cardiac surgery units, according to research presented today at the American ...

Recommended for you

Catheterization increasing for seniors with STEMI

date 31 minutes ago

(HealthDay)—From 1999 to 2009 there was a decrease in the proportion of older adults with ST-segment elevation acute myocardial infarction (STEMI) who did not undergo cardiac catheterization, according ...

Race influences warfarin dose, study says

date 8 hours ago

A new report demonstrates that clinical and genetic factors affecting dose requirements for warfarin vary by race. The study, published online today in Blood, the Journal of the American Society of Hematology (ASH), propose ...

Even moderate BMI reduction could ease A-fib burden

date 11 hours ago

(HealthDay)—Incremental increases in body mass index (BMI) are associated with excess risk of incident, postoperative, and post-ablation atrial fibrillation (AF), according to a review published online ...

Personalized saline may provide solution to heart death

date 13 hours ago

Saline solution is a staple of every hospital. No matter the ailment, doctors have known for more than a century that saline is key to keeping patients hydrated and maintaining their blood pressure levels. ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.