The Particulars: In 2011, the ACC /American Heart Association/The Society for Cardiovascular Angiography and Intervention-based guidelines for primary and elective PCI at hospitals without onsite cardiac surgery were expanded to classes lla and llb, respectively. Few studies have evaluated the introduction of PCI at hospitals without onsite cardiac surgery.
Data Breakdown: A pilot program in California was initiated to compare PCI results at hospitals with and without onsite cardiac surgery. At hospitals without onsite cardiac surgery, 5,155 PCIs were performed between July 2011 and July 2013, compared with 208,796 PCIs at hospitals with onsite cardiac surgery. Hospitals without cardiac surgery performed proportionately more primary PCIs (32.0%) than hospitals with cardiac surgery (17.9%) and showed a significantly better PCI composite safety endpoint (1.9% vs 2.4%). However, hospitals without cardiac surgery had worse composite efficacy endpoints (88.4%) than hospitals with cardiac surgery (91.0%).
Take Home Pearls: Hospitals without onsite cardiac surgery appear to offer slightly safer PCI procedures than hospitals with onsite cardiac surgery. However, results appear to be more successful at sites with cardiac surgery.