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Study Finds PCI Safe, Effective Despite Off-Site Cardiac Surgery
Date:3/29/2008

Emergency bypass surgery is rare -- it's needed in about 0.3 percent of PCI patients -- but the mortality rate is high, about 13 percent.

For the new study, Dr. Kutcher and co-investigators analyzed data from the NCDR CathPCI Registry (an ACC initiative conducted in partnership with SCAI) on 9,029 patients treated at 61 medical centers with off-site cardiac surgical back-up and 299,132 patients treated at 404 medical centers with on-site cardiac surgery programs. Programs with off-site surgical back-up tended to be smaller -- more than half of the medical centers had fewer than 200 beds -- and to perform fewer PCIs. Only 30 percent of off-site programs performed more than 200 PCI procedures annually, and only 43 percent performed more than 36 primary PCIs annually, as compared with 94 percent and 80 percent of on-site centers, respectively (p<0.0001). In addition, off-site hospitals treated higher-risk patients: Some 41 percent of patients treated at off-site centers were experiencing a heart attack at the time of PCI, as compared with 29 percent of patients treated at on-site centers (p<0.0001).

Still, the two types of hospitals had similar rates of procedural success (94 percent for off-site centers vs. 93 percent for on-site centers), overall complications (6.4 percent vs. 6.3 percent, respectively), emergency surgery (0.31 percent vs. 0.37 percent), and mortality with emergency surgery (13.64 percent vs. 12.59 percent). In a risk-adjusted analysis, hospitals with on-site cardiac surgery were more likely to perform emergency bypass surgery, but overall in-hospital mortality was no different in the two groups (odds ratio, 1.08 for on-site vs. off-site centers, p=0.507).

That the hospitals in this study voluntarily chose to submit data to the NCDR is one sign of their commitment to quality, Dr. Kutcher said. Two additional statistics are telling: 92 percent of PCI centers with off-site surgery were prepared to do PCI 24 hours a days, seven day
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SOURCE SCAI-ACCi2
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