AHA
Scientific Sessions 2011
ORLANDO, Fla. — Non-emergency artery-opening angioplasty or stent implantation performed at hospitals without on-site cardiac surgery was associated with outcomes as goods as patients whose performed was performed at hospitals with cardiac surgery capability, researchers reported here.
The Cardiovascular Patient Outcomes Research Team (CPORT) calculated a
6-week mortality rate of 0.91% for patients who underwent elective angioplasty
at a hospital without on-site cardiac surgery compared with a rate of 0.93% at
a hospital with on-site cardiology (P=.94). In addition, emergency coronary artery surgery was rarely required, but was used more frequently at hospitals with surgical capability; emergency surgery was required for 0.1% of patients who underwent procedures at hospitals without on-site surgery compared with 0.2% of patients treated at hospitals with on-site cardiac surgery. Emergency surgery was required for 20
of the patients who underwent procedures at hospitals without on-site surgery
and 10 of the patients treated at hospitals with on-site cardiac surgery.
For the study, researchers randomly assigned nearly 14,000 patients to
have their procedure performed at a hospital with cardiac surgery capabilities
and 4,500 patients at hospitals without.
According to data presented by Thomas Aversano, MD, there were no significant differences in the incidence of other major adverse events, including stroke, bleeding, renal failure and need for vascular repair in patients treated at hospitals with or without cardiac surgery on site.
“In hospitals without on-site cardiac surgery that complete a
formal PCI development program, adhere to C-PORT participation requirements and whose
outcomes are monitored, non-primary
PCI is safe and associated with similar rates of adverse
events, including mortality,” Aversano, associate professor of medicine at
Johns Hopkins Medicine Heart & Vascular Institute, said.
During the press conference, Robert Harrington, MD, director of
the Duke Clinical Research Institute, said longer-term follow-up on mortality
and economic implications are required to determine the safety of procedures
performed at hospitals without on-site cardiac surgery capabilities. He added,
“We need to better understand the subset of patients who needed emergency
procedures, either PCI or CABG, [and] we need to give some policy thought to
the notion of what happens as you expand centers with a fixed amount of cardiac
volume.” – by Casey Murphy
For more information:
Disclosure: Dr. Aversano reports funding from participating
hospitals. Dr. Harrington reports no relevant financial disclosures.
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George W.
Vetrovec
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The success of all of these programs is dependent upon the quality of
the personnel, both the physicians as well as trained staff, in a hospital that
is committed to provide the appropriate devices and equipment to make it safe.
It’s not something that can be done by putting a few catheters on the
shelf and doing a few of these [procedures]. It’s important that it has to
be a program dedicated to doing this right. The hospital has to commit to it.
That is one of the things that having an on-site surgery program provides. It
serves as an affirmation that the hospital is committed to the program and is
going to train people with the appropriate equipment.
– George W. Vetrovec, MD
Professor of medicine
Virginia Commonwealth University Medical Center
Disclosure: Dr. Vetrovec reports no relevant financial
disclosures.