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Angioplasty Safe at Hospitals Without On-Site Surgery: Review
Date:12/13/2011

By Denise Mann
HealthDay Reporter

TUESDAY, Dec. 13 (HealthDay News) -- Despite current guidelines, many people who have angioplasty to open blocked heart arteries can safely undergo these procedures in hospitals that don't have on-site cardiac surgery capabilities, according to a new review of 15 studies.

The review found no heightened risk for death or conversion to emergency bypass surgery in individuals who have angioplasty at centers that don't have teams that are ready to perform emergency coronary artery bypass grafting in a pinch.

The findings are published in the Dec. 14 issue of the Journal of the American Medical Association.

Angioplasty can be done urgently after a heart attack or electively to reduce the risk of a heart attack. The new study included more than 120,000 people who had angioplasty immediately following a heart attack. In this setting, timing is of the essence. The risk of dying was 7.2 percent at hospitals where there was on-site surgery and 4.6 percent at centers that did not have this capability. The risk of needing emergency bypass surgery was low for urgent and elective angioplasty patients at centers with and without on-site surgery capabilities, the study showed.

According to guidelines from the American College of Cardiology and American Heart Association, elective angioplasties should only be performed in centers with on-site surgery capabilities. But "for the most part, elective or non-urgent angioplasty can safely be performed at all centers," said study author Dr. Mandeep Singh, a cardiologist at the Mayo Clinic in Rochester, Minn.

"Patients who need primary, emergency angioplasty should be sent to the hospital nearest to where they live," he said. "For elective angioplasty procedures which can wait, it can be decided on a case-by-case basis."

Dr. Scott Kinlay, who wrote an accompanying journal editorial, agreed. "Patients should know that
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