Is Angioplasty at Centers Without Surgical Backup Safe?

Performing coronary angioplasties at hospitals without surgical backup seems to be safe for a wide variety of patients, from those presenting ST-segment elevation myocardial infarction to those undergoing elective procedures.

This work responds to a long-running debate over whether centers without on-site surgery capabilities in case of complications can be considered as referral centers for primary angioplasty (emergency angioplasty) only, or can also perform scheduled procedures.

Centers without surgical capabilities have argued in their defense that the performance of scheduled procedures ensured that proper proficiency be maintained for emergency cases.

This is the first real-world study showing that it is probably safe to perform coronary angioplasties at centers without surgical backup.

The study included data from the Nationwide Inpatient Sample of almost 7 million patients who received an angioplasty in the United States between 2003 and 2012. Overall, 5.7% of the procedures were performed at centers without surgical backup, and the proportion increased with time (1.8% in 2003 vs. 12.7% in 2013; p < 0.001).

Hospitals lacking surgical backup performed primary angioplasties more frequently than larger centers with surgical capabilities (34% vs. 20%; p < 0.001).

• The rate for non-ST-segment elevation acute coronary syndrome was similar (41.8% vs. 42.6%).
• Scheduled angioplasties were more frequent at centers with surgical capabilities (24.1% vs. 38.2%).
• Mortality was lower at centers with on-site surgery (1.4% vs. 1.9%; odds ratio [OR] 0.74), but the difference disappeared after researchers adjusted for procedural indication (elective or emergency procedure).

The annual angioplasty volume was less than 200 annual cases in two-thirds of the centers without surgical backup.

Original title: Outcomes and Temporal Trends of Inpatient Percutaneous Coronary Intervention at Centers With and Without On-site Cardiac Surgery in the United States.

Presenter:  Goel K.

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