CHICAGO—Hospitals that don't offer cardiac surgery had noninferior outcomes with percutaneous coronary intervention (PCI) compared to surgical hospitals, according to a trial presented at the annual meeting of the American College of Cardiology.
Researchers randomized more than 18,000 patients to undergo PCI at hospitals with on-site cardiac surgery (4,718 patients) or without on-site cardiac surgery (14,149 patients). The primary endpoints were six-week all-cause mortality and nine-month rates of major adverse cardiovascular events. The mortality rates were similar between the two groups of hospitals: 0.9% at the non-surgery ones and 1.0% at the surgical ones. The adverse event rate was 12.1% in the non-surgical hospital group compared to 11.2% in the surgical hospital arm (P=0.05 for noninferiority).
However, the trial did find that rates of target-vessel revascularization (which included repeat PCI or coronary artery bypass grafting) were higher in the group treated at hospitals without on-site surgery. “The reason for this is not clear from the current study but may reflect a lower initial success rate and a more conservative approach by interventionalists practicing at relatively inexperienced centers,” the authors concluded.
In a press conference at the ACC meeting, lead study author Thomas Aversano, MD, emphasized the importance of the preparation process that all of the non-surgical hospitals underwent before beginning the trial. “These hospitals did not simply buy stents and guidewire and start doing angioplasty. They went through a formal development program,” he said. “What the study says is yes, this is an option. You shouldn't go out and expand willy-nilly.”
The trial was presented at ACC and published online by the New England Journal of Medicine on March 25.
—By Stacey Butterfield, Associate Editor