1
|
Nguyen TC, Keegan P, Nguyen S, Loyalka P, Kaneko T, Shah PB, Grubb KJ, Babaliaros VC. Balloon-expandable transcatheter aortic valve replacement outcomes by procedure location: Catheterization laboratory versus operating room. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:149-154. [PMID: 31178348 DOI: 10.1016/j.carrev.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/20/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The impact of procedure location on clinical outcomes after TAVR remains unclear. We aimed to compare short-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) in the catheterization laboratory (CATH) versus surgical operating room (OR). METHODS A retrospective review of 63,581 trans-femoral TAVR patients using balloon-expandable valves from 2015 to 2018 were captured utilizing the TVT Registry. Propensity score matching was performed using 24 covariates resulting in 2 risk-adjusted groups. Patients were further stratified by STS Risk Score with outcomes compared. RESULTS Propensity score matching resulted in 24,160 risk-matched CATH and OR patient pairs. Short-term clinical outcomes including all-cause mortality, stroke, major vascular complications, life-threatening bleeding, and new dialysis were similar between CATH and OR (p = all ns). There was no difference in conversion to open heart surgery between CATH and OR with both occurring at a very low rate (0.4% vs. 0.5%, p = 0.07). Moreover, the 30-day survival post-conversion was similar whether TAVR was performed in CATH versus OR (43.3% and 49.7%, p = 0.28). When stratified by STS Risk Score, there was no difference in conversion to surgery or 30-day mortality in low and intermediate risk patients between CATH and OR. For high risk patients, however, conversion to surgery was lower in CATH vs. OR (0.2% vs. 0.4%, p = 0.04) with no difference in 30-day survival (46% vs. 43%, p = 0.94). CONCLUSIONS Procedure location has minimal impact on TAVR procedural and 30-day outcomes with a very low conversion to open surgery rate between CATH versus OR for low, intermediate, and high-risk patients.
Collapse
Affiliation(s)
- Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, University of Texas Medical School at Houston, Houston, TX, USA.
| | - Patricia Keegan
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie Nguyen
- Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, University of Texas Medical School at Houston, Houston, TX, USA
| | - Pranav Loyalka
- Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, University of Texas Medical School at Houston, Houston, TX, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Pinak B Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
2
|
Hannan EL, Zhong Y, Wu Y, Berger PB, Jacobs AK, Walford G, Venditti FJ, Ling FSK, Tamis-Holland J, King SB. Treatment of Coronary Artery Disease and Acute Myocardial Infarction in Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Interv 2019; 12:e007097. [PMID: 30616362 DOI: 10.1161/circinterventions.118.007097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many studies have revealed no outcome differences among patients undergoing percutaneous coronary intervention (PCI) in hospitals with and without surgery on-site (SOS), but one earlier study found differences in target vessel PCI rates and in mortality for patients with acute myocardial infarction who did not undergo PCI. It is important to examine outcome differences between SOS and non-SOS hospitals with more contemporary data. METHODS AND RESULTS A total of 21 924 propensity-matched patients who were discharged between January 1, 2013, and November 30, 2015, who were in the New York PCI registry and other hospital databases were used to compare outcomes in hospitals with and without SOS for all patients and for patients with and without ST-segment-elevation myocardial infarction (STEMI) undergoing PCI. Also, 30-day mortality was compared for patients with STEMI regardless of whether they underwent PCI. For all patients with PCI and patients without STEMI, there were no significant differences in in-hospital/30-day mortality, 2-year mortality, or 2-year repeat target lesion PCI. For patients with STEMI, there were no significant mortality differences between patients in SOS and non-SOS hospitals. Patients with STEMI in SOS hospitals had significantly lower 2-year repeat target lesion PCI rates (adjusted hazard ratio, 0.68 [0.49-0.94]). There was no difference in the percentage of patients undergoing PCI in the 2 types of hospitals (75.7% versus 74.6%; P=0.21) or in 30-day mortality of all patients with STEMI (patients who did and did not undergo PCI, 10.86% versus 11.32%; adjusted odds ratio, 1.06 [0.88-1.29]). CONCLUSIONS Short-term and long-term outcomes were not different in SOS and non-SOS hospitals except that 2-year repeat target lesion PCI rates were lower in SOS hospitals for patients with STEMI.
Collapse
Affiliation(s)
- Edward L Hannan
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Ye Zhong
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Yifeng Wu
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | | | - Alice K Jacobs
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Gary Walford
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Ferdinand J Venditti
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Frederick S K Ling
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Jacqueline Tamis-Holland
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| | - Spencer B King
- Cardiac Services Program, University at Albany, State University of New York (E.L.H., Y.Z., Y.W.)
| |
Collapse
|
3
|
Koolen KHAJ, Mol KA, Rahel BM, Eerens F, Aydin S, Troquay RPT, Janssen L, Tonino WAL, Meeder JG. Off-site primary percutaneous coronary intervention in a new centre is safe: comparing clinical outcomes with a hospital with surgical backup. Neth Heart J 2016; 24:581-8. [PMID: 27595816 PMCID: PMC5039129 DOI: 10.1007/s12471-016-0872-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To evaluate the procedural and clinical outcomes of a new primary percutaneous coronary intervention (PPCI) centre without surgical back-up (off-site PCI) and to investigate whether these results are comparable with a high volume on-site PCI centre in the Netherlands. BACKGROUND Controversy remains about the safety and efficacy of PPCI in off-site PCI centres. METHODS We retrospectively analysed clinical and procedural data as well as 6‑month follow-up of 226 patients diagnosed with ST-elevated myocardial infarction (STEMI) who underwent PPCI at VieCuri Medical Centre Venlo and 115 STEMI patients who underwent PPCI at Catharina Hospital Eindhoven. RESULTS PPCI patients in VieCuri Medical Centre had similar procedural and clinical outcomes to those in Catharina Hospital. Overall there were no significant differences. The occurrence of procedural complications was low in both groups (8.4 % VieCuri vs. 12.3 % Catharina Hospital). In the VieCuri group there was one procedural-related death. No patients in either group needed emergency surgery. At 30 days, 17 (7.9 %) patients in the VieCuri group and 9 (8.1 %) in the Catharina Hospital group had a major adverse cardiac event. CONCLUSION Performing PPCI in an off-site PCI centre is safe and effective. The study results show that the procedural and clinical outcomes of an off-site PPCI centre are comparable with an on-site high-volume PPCI centre.
Collapse
Affiliation(s)
- K H A J Koolen
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands.
| | - K A Mol
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - B M Rahel
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - F Eerens
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - S Aydin
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - R P T Troquay
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - L Janssen
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - W A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - J G Meeder
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| |
Collapse
|
4
|
Lee JM, Hwang D, Park J, Kim KJ, Ahn C, Koo BK. Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup. Circulation 2015; 132:388-401. [DOI: 10.1161/circulationaha.115.016137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/03/2015] [Indexed: 01/16/2023]
Abstract
Background—
Emergency coronary artery bypass grafting for unsuccessful percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate the current safety and outcomes of primary PCI and nonprimary PCI at centers with and without on-site surgical backup.
Methods and Results—
We performed an updated systematic review and meta-analysis by using mixed-effects models. We included 23 high-quality studies that compared clinical outcomes and complication rates of 1 101 123 patients after PCI at centers with or without on-site surgery. For primary PCI for ST-segment–elevation myocardial infarction (133 574 patients), all-cause mortality (without on-site surgery versus with on-site surgery: observed rates, 4.8% versus 7.2%; pooled odds ratio [OR], 0.99; 95% confidence interval, 0.91–1.07;
P
=0.729;
I
2
=3.4%) or emergency coronary artery bypass grafting rates (observed rates, 1.5% versus 2.4%; pooled OR, 0.76; 95% confidence interval, 0.56–1.01;
P
=0.062;
I
2
=42.5%) did not differ by presence of on-site surgery. For nonprimary PCI (967 549 patients), all-cause mortality (observed rates, 1.6% versus 2.1%; pooled OR, 1.15; 95% confidence interval, 0.94–1.41;
P
=0.172;
I
2
=67.5%) and emergency coronary artery bypass grafting rates (observed rates, 0.5% versus 0.8%; pooled OR, 1.14; 95% confidence interval, 0.62–2.13;
P
=0.669;
I
2
=81.7%) were not significantly different. PCI complication rates (cardiogenic shock, stroke, aortic dissection, tamponade, recurrent infarction) also did not differ by on-site surgical capability. Cumulative meta-analysis of nonprimary PCI showed a temporal decrease of the effect size (OR) for all-cause mortality after 2007.
Conclusions—
Clinical outcomes and complication rates of PCI at centers without on-site surgery did not differ from those with on-site surgery, for both primary and nonprimary PCI. Temporal trends indicated improving clinical outcomes in nonprimary PCI at centers without on-site surgery.
Collapse
Affiliation(s)
- Joo Myung Lee
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Doyeon Hwang
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Jonghanne Park
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Kyung-Jin Kim
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Chul Ahn
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| | - Bon-Kwon Koo
- From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.)
| |
Collapse
|
5
|
Gössl M, Rihal CS, Lennon RJ, Singh M. Assessment of individual operator performance using a risk-adjustment model for percutaneous coronary interventions. Mayo Clin Proc 2013; 88:1250-8. [PMID: 24182704 DOI: 10.1016/j.mayocp.2013.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the applicability of the Mayo Clinic Risk Score (MCRS) in the assessment of performance metrics of individual interventional cardiologists at 3 Mayo Clinic sites. PARTICIPANTS AND METHODS We evaluated the risk-adjusted performance of 21 interventional cardiologists who performed 8187 percutaneous coronary intervention procedures at 3 Mayo Clinic sites from January 1, 2007, through December 31, 2010. Observed mortality, major adverse cardiac events (MACEs) (eg, death, Q-wave myocardial infarction, urgent or emergent coronary artery bypass graft, and stroke), and expected risk were estimated using the MCRS. To compare individual performance against the other operators, risk estimates were recalibrated by excluding the individual performer from logistic regression models. RESULTS The log odds ratio for observed vs estimated risk was estimated for each interventional cardiologist, and their individual effects were then plotted on a normal probability plot to identify outliers. Observed in-hospital mortality was not different than expected (1.8% vs 1.6%; P=.24); however, the postprocedural MACE rate was lower than predicted (observed, 2.7%; expected, 3.8%; P<.001). All but one interventional cardiologist had MACE and death rates within the expected variation. Detailed assessment of that operator's risk performance produced excellent outcomes (observed vs expected MACE rate, 1.0% vs 4.4%). CONCLUSION The MCRS can serve as a tool for the assessment of performance metrics for interventional cardiologists, and risk-adjusted outcomes may serve as a better surrogate for institutional quality metrics.
Collapse
Affiliation(s)
- Mario Gössl
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | | |
Collapse
|
6
|
Mol KA, Rahel BM, Eerens F, Aydin S, Troquay RPT, Meeder JG. The first year of the Venlo percutaneous coronary intervention program: procedural and 6-month clinical outcomes. Neth Heart J 2013; 21:449-55. [PMID: 23975617 PMCID: PMC3776073 DOI: 10.1007/s12471-013-0447-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives Analysis of the first results of off-site percutaneous coronary interventions (PCI) and fractional flow reserve (FFR) measurements at VieCuri Medical Centre for Northern Limburg in Venlo. Background Off-site PCI is accepted in the European and American Cardiac Guidelines as the need for PCI increases and it has been proven to be a safe treatment option for acute coronary syndrome. Methods Retrospective cohort study reporting characteristics, PCI and FFR specifications, complications and 6-month follow-up for all consecutive patients from the beginning of off-site PCI in Venlo until July 2012. If possible, the data were compared with those of Medical Centre Alkmaar, the first off-site PCI centre in the Netherlands. Results Of the 333 patients, 19 (5.7 %) had a procedural complication. At 6 months, a major adverse cardiovascular event (MACE) occurred in 43 (13.1 %) patients. There were no deaths or emergency surgery related to the PCI or FFR procedures. There was no significant difference in occurrence of a MACE or adverse cerebral event between the Alkmaar and Venlo population in the 30-day follow-up. Conclusion This study demonstrates off-site PCI at VieCuri Venlo to have a high success rate. Furthermore, there was a low complication rate, low MACE and no procedure-related mortality.
Collapse
Affiliation(s)
- K A Mol
- Department of Cardiology, VieCuri Medical Center Venlo, Tegelseweg 210, 5912BL, Venlo, the Netherlands,
| | | | | | | | | | | |
Collapse
|
7
|
Jacobs AK, Normand SLT, Mauri L. PCI at hospitals with or without on-site cardiac surgery. N Engl J Med 2013; 369:392. [PMID: 23883385 DOI: 10.1056/nejmc1306996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
8
|
Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | |
Collapse
|
9
|
ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. J Am Coll Cardiol 2013; 62:357-96. [DOI: 10.1016/j.jacc.2013.05.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
10
|
Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, Dehmer GJ, Deychak YA, Jneid H, Jollis JG, Landzberg JS, Levine GN, McClurken JB, Messenger JC, Moussa ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, White CJ, Williams ES. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013; 128:436-72. [PMID: 23658439 DOI: 10.1161/cir.0b013e318299cd8a] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
11
|
Oqueli E. Current state of the performance of percutaneous coronary intervention in centres without on-site cardiac surgery. Intern Med J 2012; 42 Suppl 5:58-67. [PMID: 23035684 DOI: 10.1111/j.1445-5994.2012.02898.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Before the routine use of coronary stents, potential complications of percutaneous coronary interventions required the presence of backup cardiac surgery on-site. Advances in pharmacotherapy and interventional techniques, particularly in the last decade, have significantly decreased the rates of complications requiring emergency cardiac surgery, from approximately 4% to 6% in the balloon angioplasty era to as low as 0.3% to 0.6% in the contemporary era of routine intracoronary stent implantation. An early invasive approach has been shown to improve outcomes among patients with non-ST elevation acute coronary syndromes (NSTEACS), particularly in those at the highest risk, emphasising the importance of early access to revascularisation premises in such patients. Patients with ST-segment elevation myocardial infarction require immediate and sustained recanalisation of the culprit vessel to obtain rapid reperfusion of the threatened myocardium, in order to reduce infarct size and improve outcomes. Primary percutaneous coronary intervention at hospitals without on-site cardiac surgery improves clinical outcomes and reduces length of stay when compared with fibrinolytic therapy. It also significantly reduces door-to-balloon times when compared with transfer for percutaneous coronary interventions at hospitals with on-site surgery. It has been published that risk-adjusted mortality rates for patients undergoing percutaneous coronary interventions in centres without on-site surgical backup are comparable with those of percutaneous coronary intervention facilities that have cardiac surgery on-site, regardless of whether percutaneous coronary intervention was performed as primary therapy for ST-segment elevation myocardial infarction or in a non-primary setting. To achieve these results however, an adequate percutaneous coronary intervention programme is required, including proper hospital infrastructure and appropriately trained interventional cardiologists.
Collapse
Affiliation(s)
- E Oqueli
- Ballarat Health Services, Ballarat, Victoria, Australia.
| |
Collapse
|
12
|
Girotra S, Cram P. Universal access to a percutaneous coronary intervention hospital: is it feasible or desirable? Circ Cardiovasc Qual Outcomes 2012; 5:9-11. [PMID: 22253368 DOI: 10.1161/circoutcomes.111.964270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Shahian DM, Meyer GS, Yeh RW, Fifer MA, Torchiana DF. Percutaneous coronary interventions without on-site cardiac surgical backup. N Engl J Med 2012; 366:1814-23. [PMID: 22571203 DOI: 10.1056/nejmra1109616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David M Shahian
- Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
| | | | | | | | | |
Collapse
|
14
|
Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, Hermiller JB, Kinlay S, Landzberg JS, Laskey WK, McKay CR, Miller JM, Moliterno DJ, Moore JWM, Oliver-McNeil SM, Popma JJ, Tommaso CL. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012; 59:2221-305. [PMID: 22575325 DOI: 10.1016/j.jacc.2012.02.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
15
|
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
16
|
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:e652-735. [PMID: 22064599 DOI: 10.1161/cir.0b013e31823c074e] [Citation(s) in RCA: 390] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
17
|
Zia MI, Wijeysundera HC, Tu JV, Lee DS, Ko DT. Percutaneous Coronary Intervention With vs Without On-Site Cardiac Surgery Backup: A Systematic Review and Meta-analysis. Can J Cardiol 2011; 27:664.e9-16. [DOI: 10.1016/j.cjca.2010.12.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/07/2010] [Indexed: 11/29/2022] Open
|
18
|
Zhang Q, Zhang RY, Qiu JP, Zhang JF, Wang XL, Jiang L, Liao ML, Zhang JS, Hu J, Yang ZK, Shen WF. One-Year Clinical Outcome of Interventionalist- Versus Patient-Transfer Strategies for Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2011; 4:355-62. [DOI: 10.1161/circoutcomes.110.958785] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Qi Zhang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Rui Yan Zhang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Jian Ping Qiu
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Jun Feng Zhang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Xiao Long Wang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Li Jiang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Min Lei Liao
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Jian Sheng Zhang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Jian Hu
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Zheng Kun Yang
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| | - Wei Feng Shen
- From the Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.Z., R.Y.Z., J.S.Z., J.H., Z.K.Y., W.F.S.); Department of Cardiology, Shanghai Pudong Gongli Hospital (J.P.); Department of Cardiology, Shanghai No. 3 People's Hospital, Shanghai Jiaotong University School of Medicine (J.F.Z.); Department of Cardiology, Shanghai ShuGuang Hospital, University of Traditional Chinese Medicine (X.L.W.); Department of Cardiology, Shanghai Changning Center Hospital (L.J
| |
Collapse
|
19
|
Outcomes of Nonemergent Percutaneous Coronary Intervention With and Without On-site Surgical Backup: A Meta-Analysis. Am J Ther 2011; 18:e22-8. [DOI: 10.1097/mjt.0b013e3181bc0f5a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Austin PC. Primer on statistical interpretation or methods report card on propensity-score matching in the cardiology literature from 2004 to 2006: a systematic review. Circ Cardiovasc Qual Outcomes 2010; 1:62-7. [PMID: 20031790 DOI: 10.1161/circoutcomes.108.790634] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Propensity-score matching is frequently used in the cardiology literature. Recent systematic reviews have found that this method is, in general, poorly implemented in the medical literature. The study objective was to examine the quality of the implementation of propensity-score matching in the general cardiology literature. METHODS AND RESULTS A total of 44 articles published in the American Heart Journal, the American Journal of Cardiology, Circulation, the European Heart Journal, Heart, the International Journal of Cardiology, and the Journal of the American College of Cardiology between January 1, 2004, and December 31, 2006, were examined. Twenty of the 44 studies did not provide adequate information on how the propensity-score-matched pairs were formed. Fourteen studies did not report whether matching on the propensity score balanced baseline characteristics between treated and untreated subjects in the matched sample. Only 4 studies explicitly used statistical methods appropriate for matched studies to compare baseline characteristics between treated and untreated subjects. Only 11 (25%) of the 44 studies explicitly used statistical methods appropriate for the analysis of matched data when estimating the effect of treatment on the outcomes. Only 2 studies described the matching method used, assessed balance in baseline covariates by appropriate methods, and used appropriate statistical methods to estimate the treatment effect and its significance. CONCLUSIONS Application of propensity-score matching was poor in the cardiology literature. Suggestions for improving the reporting and analysis of studies that use propensity-score matching are provided.
Collapse
Affiliation(s)
- Peter C Austin
- Institute for Clinical Evaluative Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M4N 3M5, Canada.
| |
Collapse
|
21
|
Hannan EL, Zhong Y, Racz M, Jacobs AK, Walford G, Cozzens K, Holmes DR, Jones RH, Hibberd M, Doran D, Whalen D, King SB. Outcomes for Patients With ST-Elevation Myocardial Infarction in Hospitals With and Without Onsite Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Interv 2009; 2:519-27. [DOI: 10.1161/circinterventions.109.894048] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The benefit of primary percutaneous coronary interventions (P-PCI) for patients with ST-elevation myocardial infarction (STEMI) has been well documented. However, controversy still exists as to whether PCI should be expanded to hospitals without coronary artery bypass graft surgery.
Methods and Results—
Patients who were discharged after PCI for STEMI between January 1, 2003, and December 12, 2006, in P-PCI centers (hospitals with no coronary artery bypass graft surgery, and PCI only for patients with STEMI) were propensity matched with patients in full service centers, and mortality and subsequent revascularization rates were compared. For patients undergoing PCI, there were no differences for in-hospital/30-day mortality (2.3% for P-PCI centers versus 1.9% for full service centers [
P
=0.40]), emergency coronary artery bypass graft surgery immediately after PCI (0.06% versus 0.35%,
P
=0.06), 3-year mortality (7.1% versus 5.9%,
P
=0.07), or 3-year subsequent revascularization (23.8% versus 21.5%,
P
=0.52). P-PCI centers had a lower same/next day coronary artery bypass graft rate (0.23% versus 0.69%,
P
=0.046) and higher repeat target vessel PCI rates (12.1% versus 9.0%,
P
=0.003). For patients with STEMI who did not undergo PCI, P-PCI centers had higher in-hospital mortality (28.5% versus 22.3%; adjusted odds ratio, 1.38; 95% CI, 1.10 to 1.75).
Conclusions—
No differences between P-PCI centers and full service centers were found in in-hospital/30-day mortality, the need for emergency surgery, 3-year mortality or subsequent revascularization, but P-PCI centers had higher repeat target vessel PCI rates and higher mortality rates for patients who did not undergo PCI. P-PCI centers should be monitored closely, including the monitoring of patients with STEMI who did not undergo PCI.
Collapse
Affiliation(s)
- Edward L. Hannan
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Ye Zhong
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Michael Racz
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Alice K. Jacobs
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Gary Walford
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Kimberly Cozzens
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - David R. Holmes
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Robert H. Jones
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Mary Hibberd
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Donna Doran
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Deborah Whalen
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| | - Spencer B. King
- From the University at Albany (E.L.H., M.R., Y.Z., K.C.), State University of New York; Albany College of Pharmacy and Health Sciences (M.R.), Albany, NY; New York State Department of Health (M.R., D.D.), Albany, NY; Boston Medical Center (A.K.J., D.W.), Boston, Mass; St Joseph’s Hospital (G.W.), Syracuse, NY; Mayo Clinic (D.R.H.), Rochester, Minn; Duke University Medical Center (R.H.J.), Durham, NC; SUNY Stony Brook (M.H.), Stony Brook, NY; and St Joseph’s Hospital (S.B.K.), Atlanta, Ga
| |
Collapse
|
22
|
Dehmer GJ, Kutcher MA. ST-Segment-Elevation Myocardial Infarction Treated at Hospitals With and Without On-Site Cardiac Surgery. Circ Cardiovasc Interv 2009; 2:497-9. [DOI: 10.1161/circinterventions.109.921346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory J. Dehmer
- From the Department of Medicine (G.J.D.), Texas A&M University Health Science Center College of Medicine; Cardiology Division (G.J.D.), Scott & White Healthcare, Temple, Tex; and Wake Forest University School of Medicine (M.A.K.), Cardiology Division, Winston-Salem, NC
| | - Michael A. Kutcher
- From the Department of Medicine (G.J.D.), Texas A&M University Health Science Center College of Medicine; Cardiology Division (G.J.D.), Scott & White Healthcare, Temple, Tex; and Wake Forest University School of Medicine (M.A.K.), Cardiology Division, Winston-Salem, NC
| |
Collapse
|
23
|
Pride YB, Canto JG, Frederick PD, Gibson CM. Outcomes Among Patients With ST-Segment–Elevation Myocardial Infarction Presenting to Interventional Hospitals With and Without On-Site Cardiac Surgery. Circ Cardiovasc Qual Outcomes 2009; 2:574-82. [DOI: 10.1161/circoutcomes.108.841296] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Primary percutaneous coronary intervention (pPCI) is the preferred reperfusion strategy for patients with ST-segment–elevation myocardial infarction (STEMI). The quality of care and safety and efficacy of pPCI at hospitals without on-site open heart surgery (No-OHS hospitals) remains an area of active investigation.
Methods and Results—
The National Registry of Myocardial Infarction enrolled 58 821 STEMI patients from 214 OHS hospitals (n=54 076) and 52 No-OHS hospitals (n=4745) with PCI capabilities from 2004 to 2006. Patients presenting to OHS hospitals had substantially lower in-hospital mortality (7.0% versus 9.8%,
P
<0.001) and were more likely to receive any form of acute reperfusion therapy (80.8% versus 70.8%,
P
<0.001). Patients who presented to OHS hospitals were more likely to receive guideline recommended medications within 24 hours of arrival. In a propensity score model matching for patient characteristics and transfer status, in-hospital mortality remained significantly lower among patients presenting to OHS hospitals (7.2% versus 9.3%,
P
=0.025). When this model was further adjusted for differences in the use of acute reperfusion therapy, medications administered within 24 hours and hospital characteristics, the mortality difference was of borderline significance (hazard ratio, 0.87; 95% CI, 0.75 to 1.01;
P
=0.067). When the propensity score analysis was restricted to patients who underwent pPCI, there was no significant difference in mortality (3.8% versus 3.3%,
P
=0.44).
Conclusions—
STEMI patients presenting to No-OHS hospitals have substantially higher mortality, are less likely to receive guideline recommended medications within 24 hours, and are less likely to undergo acute reperfusion therapy, although this difference was of borderline significance after adjusting for hospital and treatment variables. There was no difference in mortality among patients undergoing pPCI.
Collapse
Affiliation(s)
- Yuri B. Pride
- From the Department of Medicine (Y.B.P.) and Division of Cardiology (C.M.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Center for Cardiovascular Prevention, Research, and Education (J.G.C.), Watson Clinic, Lakeland, Fla; and ICON Clinical Research (P.D.F.), San Francisco, Calif
| | - John G. Canto
- From the Department of Medicine (Y.B.P.) and Division of Cardiology (C.M.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Center for Cardiovascular Prevention, Research, and Education (J.G.C.), Watson Clinic, Lakeland, Fla; and ICON Clinical Research (P.D.F.), San Francisco, Calif
| | - Paul D. Frederick
- From the Department of Medicine (Y.B.P.) and Division of Cardiology (C.M.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Center for Cardiovascular Prevention, Research, and Education (J.G.C.), Watson Clinic, Lakeland, Fla; and ICON Clinical Research (P.D.F.), San Francisco, Calif
| | - C. Michael Gibson
- From the Department of Medicine (Y.B.P.) and Division of Cardiology (C.M.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Center for Cardiovascular Prevention, Research, and Education (J.G.C.), Watson Clinic, Lakeland, Fla; and ICON Clinical Research (P.D.F.), San Francisco, Calif
| |
Collapse
|
24
|
Dehmer GJ, Brindis RG. Non–ST-Segment Elevation Myocardial Infarction Treated at Hospitals With and Without On-Site Cardiac Surgery. JACC Cardiovasc Interv 2009; 2:953-5. [DOI: 10.1016/j.jcin.2009.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/11/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
|
25
|
Tebbe U, Hochadel M, Bramlage P, Kerber S, Hambrecht R, Grube E, Hauptmann KE, Gottwik M, Elsässer A, Glunz HG, Bonzel T, Carlsson J, Zeymer U, Zahn R, Senges J. In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup. Clin Res Cardiol 2009; 98:701-7. [DOI: 10.1007/s00392-009-0045-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
|
26
|
Singh M, Gersh BJ, Lennon RJ, Ting HH, Holmes DR, Doyle BJ, Rihal CS. Outcomes of a system-wide protocol for elective and nonelective coronary angioplasty at sites without on-site surgery: the Mayo Clinic experience. Mayo Clin Proc 2009; 84:501-8. [PMID: 19483166 PMCID: PMC2688623 DOI: 10.1016/s0025-6196(11)60581-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare outcomes of percutaneous coronary interventions (PCIs) at 2 community hospitals without on-site surgery (Franciscan Skemp Healthcare and Immanuel St. Joseph's Hospital) with a center with on-site surgery (Saint Marys Hospital). PATIENTS AND METHODS Using a matched case-control design, we studied 1842 elective and 667 nonelective PCI procedures (myocardial infarction [MI]/cardiogenic shock) performed from January 1, 1999, through December 31, 2007. The quality assurance protocol included operator volume and training, application of a risk-adjustment model, transport protocol, and database participation. We compared in-hospital mortality and/or emergent coronary artery bypass surgery after PCI at Franciscan Skemp Healthcare and Immanuel St. Joseph's Hospital, which do not have on-site surgery, with Saint Marys Hospital, a medical center with the capability to perform coronary artery bypass grafting on site. RESULTS Of 22 baseline variables, significant imbalances between matched groups were present in only 3 (hyperlipidemia, history of MI, American College of Cardiology/American Heart Association B2/C type lesion) in the elective group and 2 (Canadian Cardiovascular Society class III/IV angina, multivessel disease) in the nonelective group. The primary end point occurred in 0.3%, 0.1%, and 0.6% of patients undergoing elective PCI (P=.07) and 3.3%, 3.3%, and 3.7% of patients undergoing nonelective PCI (P=.65) at Immanuel St. Joseph's Hospital, Franciscan Skemp Healthcare, and Saint Marys Hospital, respectively. The in-hospital mortality rate at Immanuel St. Joseph's Hospital and Franciscan Skemp Healthcare was comparable to that at Saint Marys Hospital for both elective (0.3%, 0.1%, 0.4%; P=.24) and nonelective PCI (2.6%, 2.4%, 3.1%; P=.49). No patient undergoing elective PCI required transfer for emergency cardiac surgery. Of the 21 transfers, 20 (95%) were in the setting of MI and cardiogenic shock or left main/3-vessel disease; 18 patients (86%) survived to discharge. CONCLUSION Optimal outcomes with PCI have been observed at community hospitals without on-site cardiac surgical programs with application of a prospective, standardized quality assurance protocol.
Collapse
Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
Singh M, Gersh BJ, Lennon RJ, Ting HH, Holmes DR, Doyle BJ, Rihal CS. Outcomes of a system-wide protocol for elective and nonelective coronary angioplasty at sites without on-site surgery: the Mayo Clinic experience. Mayo Clin Proc 2009; 84:501-8. [PMID: 19483166 PMCID: PMC2688623 DOI: 10.4065/84.6.501] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To compare outcomes of percutaneous coronary interventions (PCIs) at 2 community hospitals without on-site surgery (Franciscan Skemp Healthcare and Immanuel St. Joseph's Hospital) with a center with on-site surgery (Saint Marys Hospital). PATIENTS AND METHODS Using a matched case-control design, we studied 1842 elective and 667 nonelective PCI procedures (myocardial infarction [MI]/cardiogenic shock) performed from January 1, 1999, through December 31, 2007. The quality assurance protocol included operator volume and training, application of a risk-adjustment model, transport protocol, and database participation. We compared in-hospital mortality and/or emergent coronary artery bypass surgery after PCI at Franciscan Skemp Healthcare and Immanuel St. Joseph's Hospital, which do not have on-site surgery, with Saint Marys Hospital, a medical center with the capability to perform coronary artery bypass grafting on site. RESULTS Of 22 baseline variables, significant imbalances between matched groups were present in only 3 (hyperlipidemia, history of MI, American College of Cardiology/American Heart Association B2/C type lesion) in the elective group and 2 (Canadian Cardiovascular Society class III/IV angina, multivessel disease) in the nonelective group. The primary end point occurred in 0.3%, 0.1%, and 0.6% of patients undergoing elective PCI (P=.07) and 3.3%, 3.3%, and 3.7% of patients undergoing nonelective PCI (P=.65) at Immanuel St. Joseph's Hospital, Franciscan Skemp Healthcare, and Saint Marys Hospital, respectively. The in-hospital mortality rate at Immanuel St. Joseph's Hospital and Franciscan Skemp Healthcare was comparable to that at Saint Marys Hospital for both elective (0.3%, 0.1%, 0.4%; P=.24) and nonelective PCI (2.6%, 2.4%, 3.1%; P=.49). No patient undergoing elective PCI required transfer for emergency cardiac surgery. Of the 21 transfers, 20 (95%) were in the setting of MI and cardiogenic shock or left main/3-vessel disease; 18 patients (86%) survived to discharge. CONCLUSION Optimal outcomes with PCI have been observed at community hospitals without on-site cardiac surgical programs with application of a prospective, standardized quality assurance protocol.
Collapse
Affiliation(s)
- Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Kutcher MA, Klein LW, Ou FS, Wharton TP, Dehmer GJ, Singh M, Anderson HV, Rumsfeld JS, Weintraub WS, Shaw RE, Sacrinty MT, Woodward A, Peterson ED, Brindis RG. Percutaneous Coronary Interventions in Facilities Without Cardiac Surgery On Site: A Report From the National Cardiovascular Data Registry (NCDR). J Am Coll Cardiol 2009; 54:16-24. [DOI: 10.1016/j.jacc.2009.03.038] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 02/18/2009] [Accepted: 03/10/2009] [Indexed: 11/17/2022]
|
29
|
Peels J, Hautvast R, de Swart J, Huybregts M, Umans V, Arnold A, Jessurun G, Zijlstra F. Percutaneous coronary intervention without on site surgical back-up; two-years registry of a large Dutch community hospital. Int J Cardiol 2009; 132:59-65. [DOI: 10.1016/j.ijcard.2007.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Revised: 07/18/2007] [Accepted: 10/27/2007] [Indexed: 10/22/2022]
|
30
|
Tan ES, Jessurun G, Deurholt W, van der Vleuten P, van den Heuvel A, Ebels T, Zijlstra F, Tio R. Differences between early, intermediate, and late angioplasty after coronary artery bypass grafting. Crit Pathw Cardiol 2008; 7:239-244. [PMID: 19050420 DOI: 10.1097/hpc.0b013e3181894550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of the present study was to identify patients with recurrent ischemia after coronary artery bypass surgery (CABG) treated by percutaneous coronary intervention (PCI). Graft failure after CABG may be managed conservatively or treated by surgery or PCI. We thought to investigate clinical, angiographic, and procedural characteristics in relation to clinical outcome. This was a retrospective single-center study. Patients who underwent revascularization by PCI with a previous CABG were analyzed. Patients were divided in 3 groups, depending on interval between CABG and index PCI: group 1, interval <72 hours; group 2, interval between 72 hours and 1 year; group 3, interval >1 year. Two hundred twenty-one patients were studied. Clinical characteristics and survival curves were comparable in groups 2 and 3. Postoperative creatine kinase MB and troponin values were significantly higher in group 1 (P = 0.000). From group 1, significantly more patients (10.5%) required emergency CABG after the index PCI than compared with group 2 (2.1%) and group 3 (0%), (P = 0.003). There were more off-pump CABGs in group 1 than in the other 2 groups. Group 1 received less PCIs in native ungrafted vessels compared with the other 2 groups. Mortality in group 1 (18.4%) was higher than in the other 2 groups (7.4 and 4.5%, respectively; P < 0.05). Mortality in group 1 was higher in the acute phase of follow-up. PCI performed less than 72 hours after CABG is feasible but accompanied by a higher mortality and redo CABG. This outcome is probably related to the high-risk patient category.
Collapse
Affiliation(s)
- Eng-Shiong Tan
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Guarga A, Pla R, Benet J, Pozuelo A. Planificación de los servicios de alta especialización en Cataluña. Med Clin (Barc) 2008; 131 Suppl 4:55-9. [DOI: 10.1016/s0025-7753(08)76476-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Safety and efficacy of offsite percutaneous coronary interventions in 1,348 consecutive patients in rural Tasmania. Am J Cardiol 2008; 102:1323-7. [PMID: 18993149 DOI: 10.1016/j.amjcard.2008.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 07/08/2008] [Accepted: 07/13/2008] [Indexed: 11/22/2022]
Abstract
Despite controversy, a growing body of data exists suggesting that percutaneous coronary intervention (PCI) with no surgical onsite availability is safe and efficacious. Over a period of 3 years all patients requiring PCI had their intervention performed at the Launceston General Hospital, a regional hospital serving rural Tasmania, Australia. There were no exclusion criteria uniformly adopted. Primary end points included angiographic success and major procedure-related complications. A total cohort of 1,348 consecutive patients underwent PCI during the calendar years of 2005 through 2007, including patients with ST-elevation myocardial infarction. Angiographic success for all patients was >98%. In-hospital mortality was 0.8% overall. Only 1 patient required urgent transfer to a cardiac surgical center. Bleeding rates requiring transfusion were approximately 1%. Excellent clinical outcomes have been achieved in a relatively remote PCI center in rural, northern Tasmania, where there is no emergency cardiac surgical availability. Angiographic success was high and complication rates were low, consistent with worldwide standards. In conclusion, PCI without onsite surgery appears safe and efficacious when well-trained staffing is available.
Collapse
|
33
|
|
34
|
Gunalingam B, Bates F, Wilkes N, Hill A, Wang D. Percutaneous Coronary Interventions without On-Site Cardiac Surgery: A Remote Australian Experience. Heart Lung Circ 2008; 17:388-94. [DOI: 10.1016/j.hlc.2008.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Revised: 01/02/2008] [Accepted: 01/23/2008] [Indexed: 12/01/2022]
|
35
|
Frutkin AD, Mehta SK, Patel T, Menon P, Safley DM, House J, Barth CW, Grantham JA, Marso SP. Outcomes of 1,090 consecutive, elective, nonselected percutaneous coronary interventions at a community hospital without onsite cardiac surgery. Am J Cardiol 2008; 101:53-7. [PMID: 18157965 DOI: 10.1016/j.amjcard.2007.07.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 07/09/2007] [Accepted: 07/09/2007] [Indexed: 11/25/2022]
Abstract
We evaluated the efficacy and safety of elective percutaneous coronary intervention (PCI) at a hospital without onsite cardiac surgery. A growing number of hospitals without onsite cardiac surgery perform elective PCI. Few hospitals have reported outcomes, despite controversy surrounding this practice. From August 2003 to December 2005, 1,090 elective PCI were performed at Saint Luke's South Hospital (SLS), a hospital without onsite cardiac surgery, for which the referral center is the Mid America Heart Institute (MAHI). The elective PCI program used experienced interventionalists, technicians, and nurses; a tested helicopter transport protocol; a well-equipped catheterization laboratory; and a quality assurance process. Baseline characteristics, procedural success, and adverse clinical outcomes were compared. Observed frequencies of in-hospital death, a combined end point of Q-wave myocardial infarction (MI)/emergency coronary artery bypass grafting (CABG) surgery, and vascular complications were compared with prediction models. SLS, with lower risk characteristics than MAHI, had unadjusted frequencies of procedural success (93% vs 94%, p = NS), Q-wave MI (0.3% vs 0.3%, p = NS), emergency CABG surgery (0.2% vs 0.03%, p = 0.09), vascular complications (0.6% vs 0.6%, p = NS), and in-hospital death (0.1% vs 0.8%, p = 0.002) that compared favorably with MAHI. Two patients transferred from SLS to MAHI for emergency CABG surgery without adverse effects. Fewer in-hospital deaths and vascular complications were observed at SLS than predicted by models. In conclusion, favorable clinical outcomes were achieved for elective PCI at a hospital without onsite cardiac surgery that used strict program requirements.
Collapse
|
36
|
|
37
|
Ehsani JP, Duckett SJ, Jackson T. The incidence and cost of cardiac surgery adverse events in Australian (Victorian) hospitals 2003-2004. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2007; 8:339-46. [PMID: 17347846 DOI: 10.1007/s10198-006-0036-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 12/15/2006] [Indexed: 05/14/2023]
Abstract
The aim of this study was to estimate the incidence of adverse events in acute surgical admissions for cardiac disease in admitted episodes in the year 2003-2004 and to estimate the cost of these complications to the Victorian health system. Cardiac surgery adverse events are among the most frequent and significant contributors to the morbidity, mortality and cost associated with hospitalisation. Patient-level costing data set for major Victorian public hospitals in 2003-2004 was analysed for adverse events using C-prefixed markers, denoting complications that arose during the course of hospital treatment for cardiac surgery diagnosis related groups (DRGs). The cost of adverse events was estimated by linear regression modelling, adjusted for age and co-morbidity. A total of 16,766 multi-day cardiac disease cases were identified, of whom 6,181 (36.85%) had at least one adverse event. Patients with adverse events stayed approximately 7 days longer and had four times the case fatality rate than those without. After adjustment for age and co-morbidity, the presence of an adverse event adds AUS$5,751. The sum of the total cost of adverse events for each DRG was AUS$42.855 million, representing 21.6% of total expenditure on cardiac surgery and adding 27.5% in broad terms to the cardiac surgery budget.
Collapse
|
38
|
Lemkes J, Peels J, Huybregts R, de Swart H, Hautvast R, Umans V. Emergency cardiac surgery after a failed percutaneous coronary intervention in an interventional centre without on-site cardiac surgery. Neth Heart J 2007; 15:173-7. [PMID: 17612679 PMCID: PMC1877970 DOI: 10.1007/bf03085976] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND.: Based on experience from other countries, the Medical Centre Alkmaar was granted permission to start the first Dutch PCI programme without on-site cardiac surgery. The cardiology group of the Medical Centre Alkmaar started an off-site PCI programme in 2002 with only primary PCI in the first year and a full PCI programme from November 2003 onwards. We report the first Dutch experience with acute cardiac surgery following a failed PCI procedure in an off-site clinic. PATIENTS.: From October 2002 until February 2007, 2500 patients were treated by PCI in the Medical Centre Alkmaar. These patients were treated for an acute myocardial infarction (33%), acute coronary syndromes (37%) or progressive angina (30%). In this first series of off-site PCI in the Netherlands, the incidence of emergency cardiac surgery following failed PCI was 0.2% All five patients who needed emergency surgery underwent elective PCI for progressive stable coronary artery disease. No emergency surgery was needed for primary PCIs in patients with an acute myocardial infarction. All patients survived emergency surgery following failed PCI. CONCLUSION.: Adherence to the Dutch guidelines of interventional cardiology with protocols describing a close collaboration with cardiac surgeons and an immediate availability of rapid ground transportation are mandatory when performing off-site PCI. This series extends the current expertise of emergency surgery after failed PCI to off-site clinics. With appropriate settings, off-site PCI may not be associated with an increase in the risk of adverse events. (Neth Heart J 2007;15:173-7.).
Collapse
Affiliation(s)
- J.S. Lemkes
- Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - J.O.J. Peels
- Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - R. Huybregts
- Department of Cardiac Surgery, VU Medical Centre, Amsterdam, the Netherlands
| | - H. de Swart
- Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - R. Hautvast
- Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - V.A.W.M. Umans
- Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| |
Collapse
|
39
|
Abstract
Is the requirement for onsite surgical back-up in centres performing percutaneous coronary intervention still relevant today?
Collapse
|
40
|
Dehmer GJ, Blankenship J, Wharton TP, Seth A, Morrison DA, Dimario C, Muller D, Kellett M, Uretsky BF. The current status and future direction of percutaneous coronary intervention without on-site surgical backup: An expert consensus document from the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2007; 69:471-8. [PMID: 17278155 DOI: 10.1002/ccd.21097] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gregory J Dehmer
- Cardiology Division, Texas A&M School of Medicine, Scott & White Clinic, 2401 South 31st Street, Temple, TX 76508, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Affiliation(s)
- Gregory J Dehmer
- Texas A & M School of Medicine, and Cardiology Division, Scott & White Clinic, 2401 South 31st Street, Temple, TX 76508, USA.
| |
Collapse
|
42
|
Dehmer GJ, Kutcher MA, Dey SK, Shaw RE, Weintraub WS, Mitchell K, Brindis RG. Frequency of percutaneous coronary interventions at facilities without on-site cardiac surgical backup--a report from the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). Am J Cardiol 2007; 99:329-32. [PMID: 17261392 DOI: 10.1016/j.amjcard.2006.08.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 08/22/2006] [Accepted: 08/22/2006] [Indexed: 10/23/2022]
Abstract
The practice of performing percutaneous coronary intervention (PCI) in centers without on-site cardiac surgical backup is controversial. Using data from facilities that participated in the American College of Cardiology/National Cardiovascular Data Registry, the incidence of PCI without on-site surgical backup was evaluated. From January 1, 2001 through December 31, 2004, 39 of 449 (8.7%) centers were identified as sites that performed PCI without on-site surgical backup. By the end of 2005, 75 of 463 (16%) participating facilities were performing PCI without on-site backup. By using standardized data element definitions, it was possible to differentiate between patients who underwent elective PCI and those who had urgent nonelective PCI for acute ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction. This analysis showed that the number of elective and nonelective PCI procedures with or without on-site surgical backup per quarter had increased significantly (p <0.0001) from 2001 to 2004. The number of PCI procedures performed without on-site surgical backup continued to increase in 2005. In conclusion, the significant increase in elective PCIs performed at facilities without on-site surgical backup occurred despite national guidelines that state elective PCI should not be done in centers without on-site cardiac surgery.
Collapse
Affiliation(s)
- Gregory J Dehmer
- Texas A&M University College of Medicine and Cardiology Division, Scott & White Clinic, Temple, Texas, USA.
| | | | | | | | | | | | | |
Collapse
|
43
|
Shiraishi J, Kohno Y, Sawada T, Nishizawa S, Arihara M, Hadase M, Hyogo M, Yagi T, Shima T, Okada T, Matoba S, Yamada H, Tatsumi T, Kitamura M, Furukawa K, Matsubara H. In-Hospital Outcomes of Primary Percutaneous Coronary Interventions Performed at Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery. Circ J 2007; 71:1208-12. [PMID: 17652882 DOI: 10.1253/circj.71.1208] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is performed in hospitals without on-site coronary artery bypass graft surgery in the ;real world'. However, data on the in-hospital outcomes of primary PCI performed at hospitals with and without on-site cardiac surgery are still lacking in Japan. METHODS AND RESULTS In the present study, 2,230 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2005. Of these, 1,817 patients underwent primary PCI. Excluding patients without adequate data, we retrospectively compared clinical background, coronary risk factors, angiographic findings, acute results of primary PCI and in-hospital prognosis between patients undergoing primary PCI in hospitals without on-site cardiac surgery (without surgery group, n=792) and those in hospitals with (with surgery group, n=993). The without surgery group had higher prevalence of previous myocardial infarction, Killip class>or=3 at admission and multivessels as a culprit lesion than the with surgery group. The without surgery group was more likely to have lower frequency of stent usage and lower thrombolysis in myocardial infarction flow grade just after PCI, whereas it was more likely to have intra-aortic balloon pumping and temporary pacing during procedures. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class>or=3 at admission, multivessels or left main trunk (LMT) as culprit lesions, number of diseased vessels>or=2 or diseased LMT, and age were the independent predictors of the in-hospital mortality, but the presence of on-site cardiac surgery was not. CONCLUSIONS These results suggest that in-hospital outcomes in AMI patients undergoing primary PCI at hospitals without on-site cardiac surgery are comparable to those at hospitals with on-site cardiac surgery in Japan.
Collapse
Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital, and Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Carlsson J, James SN, Ståhle E, Höfer S, Lagerqvist B. Outcome of percutaneous coronary intervention in hospitals with and without on-site cardiac surgery standby. Heart 2006; 93:335-8. [PMID: 16980517 PMCID: PMC1861454 DOI: 10.1136/hrt.2006.098061] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare characteristics and outcome of patients undergoing percutaneous coronary intervention (PCI) in clinics with (WSB) or without (NOSB) on-site cardiac surgery backup. DESIGN Analysis according to hospital, type of prospectively collected data of all patients who underwent PCI during 2000-3. SETTING The Swedish Coronary Angiography and Angioplasty Registry covers all PCI procedures performed in Sweden. PATIENTS 34,363 patients underwent PCI between January 2000 and December 2003. 8838 procedures were performed in NOSB (mean age of patients was 64.5 years) hospitals and 25,525 in WSB (mean age of patients was 64.1 years) hospitals (p = 0.002). RESULTS More patients in NOSB hospitals had diabetes (17.8% vs 16.8%; p = 0.03). Other clinical characteristics (previous infarct, previous coronary artery bypass graft (CABG)) also showed a tendency towards worse patients being treated in NOSB hospitals. However, there was a higher percentage of patients with ST-segment elevation myocardial infarction (18% vs 9.7%; p<0.01) in WSB hospitals. After adjusting for differences in baseline risk no significant differences regarding outcome (30-day mortality, 1-year mortality, stroke and emergency CABG) were observable between WSB and NOSB hospitals. This applied to elective and non-elective procedures. CONCLUSIONS On the basis of these data it does not seem warranted to recommend against percutaneous transluminal coronary angioplasty in NOSB hospitals.
Collapse
Affiliation(s)
- Jörg Carlsson
- Department of Internal Medicine, Division of Cardiology, Länssjukhuset, Kalmar, Sweden.
| | | | | | | | | |
Collapse
|
45
|
Reply. J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|