ACC coverage: Small hospitals matched PCI outcomes at surgical facilities

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.


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