In the Journals

Outcomes similar after PCI regardless of cardiac surgery capabilities at hospitals

Edward L. Hannan
Edward L. Hannan

Patients with and without STEMI had similar short- and long-term outcomes after PCI regardless of whether a hospital performed surgery on-site, according to a study published in Circulation: Cardiovascular Interventions.

In addition, patients with STEMI who underwent PCI in surgery on-site hospitals had lower rates of repeat target lesion PCI at 2 years, according to the study.

Hospitals by PCI capabilities

Edward L. Hannan, PhD, MS, FACC, distinguished professor emeritus at University at Albany-SUNY School of Public Health, and colleagues analyzed data from 76,697 patients from the state of New York Percutaneous Coronary Intervention Reporting System registry and the Statewide Planning and Research Cooperative System who were discharged after undergoing PCI between 2013 and November 2015. Patients underwent PCI at a hospital with (n = 65,735; mean age, 66 years; 30% women) or without cardiac surgery on-site (n = 10,962; mean age; 64 years; 31% women).

The endpoints of interest for patients who underwent PCI were in-hospital mortality at 30 days, mortality at 2 years and repeat target lesion PCI at 2 years. Endpoints of interest for patients with STEMI, which included those who did not undergo revascularization, were risk-adjusted 30-day mortality and the percentage of patients who underwent revascularization.

Patients were followed up until 2015 for a median of 1.5 years for patients in surgery on-site hospitals and 1.6 years for those in hospitals without on-site surgery.

Both types of hospitals had similar rates of in-hospital mortality at 30 days (adjusted OR = 1.22; 95% CI, 0.95-1.57), mortality at 2 years (aHR = 1.06; 95% CI, 0.94-1.2) and repeat target lesion PCI at 2 years (aHR = 0.98; 95% CI, 0.86-1.11). Patients with STEMI also had similar rates regardless of hospital type for in-hospital mortality at 30 days (aOR = 0.99; 95% CI, 0.68-1.44) and mortality at 2 years (aHR = 1.09; 95% CI, 0.86-1.38). In addition, patients with STEMI who underwent PCI at surgery on-site hospitals had a lower rate of target lesion PCI at 2 years (aHR = 0.68; 95% CI, 0.49-0.94).

PCI rates by hospital type

The percentage of patients with STEMI who underwent PCI at a surgery on-site hospital was similar to those who underwent the intervention at a hospital without on-site surgery (75.7% vs. 74.6%, respectively; P = .21). When patients who were treated with PCI or medically, the rate of mortality at 30 days was similar in patients in surgery on-site hospitals and those without on-site surgery (10.86% vs. 11.32%, respectively; aOR = 1.06; 95% CI, 0.88-1.29).

“We examined the frequency of PCI for patients with STEMI, and examined mortality for all patients with STEMI, including those who did and did not undergo PCI,” Hannan and colleagues wrote. “This is important because patients not undergoing PCI have higher mortality rates in general, and patients should be undergoing PCI whenever possible.” – by Darlene Dobkowski

Disclosures: Hannan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Edward L. Hannan
Edward L. Hannan

Patients with and without STEMI had similar short- and long-term outcomes after PCI regardless of whether a hospital performed surgery on-site, according to a study published in Circulation: Cardiovascular Interventions.

In addition, patients with STEMI who underwent PCI in surgery on-site hospitals had lower rates of repeat target lesion PCI at 2 years, according to the study.

Hospitals by PCI capabilities

Edward L. Hannan, PhD, MS, FACC, distinguished professor emeritus at University at Albany-SUNY School of Public Health, and colleagues analyzed data from 76,697 patients from the state of New York Percutaneous Coronary Intervention Reporting System registry and the Statewide Planning and Research Cooperative System who were discharged after undergoing PCI between 2013 and November 2015. Patients underwent PCI at a hospital with (n = 65,735; mean age, 66 years; 30% women) or without cardiac surgery on-site (n = 10,962; mean age; 64 years; 31% women).

The endpoints of interest for patients who underwent PCI were in-hospital mortality at 30 days, mortality at 2 years and repeat target lesion PCI at 2 years. Endpoints of interest for patients with STEMI, which included those who did not undergo revascularization, were risk-adjusted 30-day mortality and the percentage of patients who underwent revascularization.

Patients were followed up until 2015 for a median of 1.5 years for patients in surgery on-site hospitals and 1.6 years for those in hospitals without on-site surgery.

Both types of hospitals had similar rates of in-hospital mortality at 30 days (adjusted OR = 1.22; 95% CI, 0.95-1.57), mortality at 2 years (aHR = 1.06; 95% CI, 0.94-1.2) and repeat target lesion PCI at 2 years (aHR = 0.98; 95% CI, 0.86-1.11). Patients with STEMI also had similar rates regardless of hospital type for in-hospital mortality at 30 days (aOR = 0.99; 95% CI, 0.68-1.44) and mortality at 2 years (aHR = 1.09; 95% CI, 0.86-1.38). In addition, patients with STEMI who underwent PCI at surgery on-site hospitals had a lower rate of target lesion PCI at 2 years (aHR = 0.68; 95% CI, 0.49-0.94).

PCI rates by hospital type

The percentage of patients with STEMI who underwent PCI at a surgery on-site hospital was similar to those who underwent the intervention at a hospital without on-site surgery (75.7% vs. 74.6%, respectively; P = .21). When patients who were treated with PCI or medically, the rate of mortality at 30 days was similar in patients in surgery on-site hospitals and those without on-site surgery (10.86% vs. 11.32%, respectively; aOR = 1.06; 95% CI, 0.88-1.29).

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“We examined the frequency of PCI for patients with STEMI, and examined mortality for all patients with STEMI, including those who did and did not undergo PCI,” Hannan and colleagues wrote. “This is important because patients not undergoing PCI have higher mortality rates in general, and patients should be undergoing PCI whenever possible.” – by Darlene Dobkowski

Disclosures: Hannan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.