Hospitals without on-site cardiac surgery can perform non-emergency angioplasty safely and effectively

March 26, 2012

(Medical Xpress) -- Patients who have non-emergency angioplasty to open blocked heart vessels have no greater risk of death or complications when they have the procedure at hospitals without cardiac surgery backup. That is the conclusion of a national a study to assess the safety and effectiveness of such procedures at community hospitals.

Results of the study, called the Cardiovascular Patient Outcomes Research Team Elective Study (C-PORT-E), are being presented on March 25 at the American College of Cardiology (ACC) annual meeting in Chicago.  The study also will be published online by the New England Journal of Medicine to coincide with the ACC presentation.

The study, led by Johns Hopkins cardiologist Thomas Aversano, evaluated the nine-month outcomes of 18,867 patients who were randomly assigned to have elective heart artery-opening angioplasty or stenting at hospitals with or without cardiac surgery capability.

“Our composite endpoints in the study—death, heart attack, and blockage again in the vessel that was opened with angioplasty—showed  similar results at nine months whether the procedure was performed at a with or without cardiac surgery backup,” says Aversano, who is an associate professor of medicine at the Johns Hopkins University School of Medicine.

He says that there was a small difference among the two groups regarding the need for revascularization—a second procedure to open the same vessel.

“We found that more patients treated at community hospitals without surgery backup required a repeat procedure within 9 months. The size of the difference in repeat procedure rates between hospitals with and without on-site cardiac surgery is small, between 11 and 17 additional procedures for every 1,000 treated patients.”   He adds, “The reason for the difference is not clear except that it may reflect a more conservative approach at treating the blockage among interventional cardiologists at hospitals without cardiac surgery capability.”

The study included 60 hospitals in 10 states without cardiac surgery backup. In order to participate in the study, those hospitals had to perform a minimum of 200 angioplasty procedures each year and develop a formal angioplasty development program to prepare their staff and establish protocols and policies.

Emergency angioplasty is performed during a heart attack, when a vessel needs to be opened right away to restore blood flow in the heart. Non-emergency procedures are offered to patients with blockages that may be causing chest pain.

During angioplasty, a tiny balloon is inflated within a coronary artery to push away plaque that is causing a blockage in the vessel. Stents, which act like tiny scaffolds, also can be put in place to keep the artery open. In rare cases, the procedure can cause a tear in the vessel or closing of the artery, requiring open heart surgery to repair the problem.

Until a recent change in guidelines by the American College of Cardiology and the American Heart Association, non-emergency angioplasty was not recommended at    without backup in case there were complications that required emergency surgery. Dr. Aversano says results of the study support the change in the guidelines.

The researchers do not believe that every hospital should be performing angioplasty. However, they wanted to know if hospitals that already offer emergency angioplasty to open blocked coronary arteries in patients can also safely and effectively perform elective angioplasty.

About 850,000 angioplasties are performed in the United States each year. “The goal of our study,” says Aversano, “is to give health care planners the best possible information on which to base their decisions about the allocation of resources, so that patients can have access to the highest quality of care.”

The CPORT study centers, which include Johns Hopkins, Duke University and Clinical Trials and Surveys Corp. (formerly the Maryland Medical Research Institute), are funded by the hospitals participating in the study.

Explore further: Patients fare just as well if their nonemergency angioplasty is performed at hospitals

Related Stories

Patients fare just as well if their nonemergency angioplasty is performed at hospitals

November 14, 2011
Hospitals that do not have cardiac surgery capability can perform nonemergency angioplasty and stent implantation as safely as hospitals that do offer cardiac surgery. That is the finding of the nation's first large, randomized ...

Angioplasties performed at centers without on-site surgery services are safe, study finds

December 13, 2011
Contrary to current guidelines, Mayo Clinic researchers have found that angioplasties performed at centers without on-site cardiac surgery capabilities pose no increased risk for patient death or emergency bypass surgery. ...

Most hospitals miss critical window for heart attack transfer patients

November 28, 2011
Most heart attack patients transferred between hospitals for the emergency artery-opening procedure called angioplasty are not transported as quickly as they should be, Yale School of medicine researchers report in the first ...

Tears during coronary angioplasty: Where are they and how do they affect patient outcomes?

March 24, 2012
Researchers from Thomas Jefferson University Hospital discovered that blockages in the right coronary artery and those in bending areas of the coronary artery are the most common places for dissection, a tear in the artery ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 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.