PCI Outcomes No Worse in Centers Without On-Site Surgery

Similar in-hospital death, emergency bypass for PCI at centers with/without on-site surgery

TUESDAY, Dec. 13 (HealthDay News) -- Similar rates of in-hospital mortality and emergency coronary artery bypass grafting (CABG) surgery for percutaneous coronary intervention (PCI) are seen at centers with and without on-site surgery, according to a review published in the Dec. 14 issue of the Journal of the American Medical Association.

Mandeep Singh, M.D., M.P.H., from the Mayo Clinic in Rochester, Minn., and colleagues reviewed the literature published from 1990 to 2010, and compared the rates of in-hospital mortality and emergency CABG for PCI performed at centers with and without on-site surgery. Data were extracted manually from 40 selected studies on study title, time period, indication for angioplasty, and outcomes; study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

The investigators found that 124,074 patients underwent PCI for ST-segment elevation myocardial infarction. For primary PCI performed at centers without on-site surgery, there was no increase in the risk of in-hospital mortality (4.6 and 7.2 percent, respectively; odds ratio [OR], 0.96; 95 percent confidence interval [CI], 0.88 to 1.05) or emergency bypass (0.22 and 1.03 percent, respectively; OR, 0.53; 95 percent CI, 0.35 to 0.79) compared to those performed at centers with on-site surgery. For nonprimary PCI, there was no significant difference for the rates of in-hospital mortality (1.4 and 2.1 percent, respectively; OR, 1.15; 95 percent CI, 0.93 to 1.41) and emergency bypass (0.17 and 0.29 percent, respectively; OR, 1.21; 95 percent CI, 0.52 to 2.85) at centers without or with on-site surgery.

"Rates of in-hospital mortality and emergency CABG surgery for primary and nonprimary PCI are similar at centers with and without on-site surgery," the authors write.

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