Percutaneous coronary intervention for ST-segment and non-ST-segment elevation myocardial infarction at hospitals
Mandeep Singh1, Henry H Ting, Bernard J Gersh
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Insights
Percutaneous coronary intervention (PCI) for acute myocardial infarction is safe and effective at hospitals without on-site cardiac surgery. Outcomes were similar to PCI performed at centers with surgical capabilities.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Percutaneous coronary intervention (PCI) is a key treatment for acute myocardial infarction (AMI).
- Concerns exist regarding the safety and efficacy of PCI for AMI at hospitals lacking on-site cardiac surgical services.
- This study addresses the comparative outcomes of PCI for AMI in different hospital settings.
Purpose of the Study:
- To compare the safety and efficacy of PCI for AMI performed at a hospital without cardiac surgical capability versus a center with on-site surgery.
- To evaluate procedural success, in-hospital adverse events, and 6-month follow-up outcomes.
- To determine if PCI for AMI can be safely performed in community hospitals without immediate surgical backup.
Main Methods:
- A comparative study design was used, including 160 patients undergoing PCI for AMI at a community hospital without on-site surgery.
- Matched controls (160 patients) undergoing PCI for AMI at a hospital with on-site cardiac surgery were identified.
- Outcomes assessed included procedural success, in-hospital adverse cardiac events, and 6-month all-cause mortality.
Main Results:
- Procedural success rates were high and comparable between the two groups (96% vs 95%, P=.79).
- In-hospital mortality, Q-wave myocardial infarction, and target vessel revascularization rates were low and similar.
- Six-month survival was high in both groups (96% vs 94%, P=.92), with no emergency transfers for failed PCI.
Conclusions:
- PCI for acute myocardial infarction can be performed safely and effectively in a community hospital setting without on-site cardiac surgery.
- The findings support the expansion of PCI services to community hospitals, improving access to care for AMI patients.
- This demonstrates that careful patient selection and established protocols enable successful PCI outcomes regardless of immediate surgical availability.
Objective:
To compare the safety and efficacy of percutaneous coronary intervention (PCI) for acute myocardial infarction performed at a hospital without cardiac surgical capability with PCI performed for acute myocardial infarction at a center with on-site surgery.
Patients And Methods:
We included patients with acute myocardial infarction in whom PCI was performed from March 1, 2000, through May 31, 2002, at a community hospital (Immanuel St Joseph's) without on-site surgery. The procedural success, in-hospital adverse cardiac events, and 6-month follow-up were compared with those of PCI performed for acute myocardial infarction in matched controls from January 1, 2000, through February 28, 2002, at a center with cardiac surgery (Saint Marys Hospital).
Results:
One hundred sixty patients (and 160 matched controls) underwent PCI for acute myocardial infarction. The procedural success rate was high and similar for the 2 groups (96% vs 95%; P=.79). In-hospital mortality, Q-wave myocardial infarction, and target vessel revascularization were low and similar for the 2 groups. No patient was referred for emergency coronary artery bypass graft surgery for failed PCI. Six-month survival from all-cause mortality was 96% for the Immanuel St Joseph's group and 94% for the Saint Marys Hospital group (P=.92). Subgroup analysis of patients with primary PCI for ST-segment elevation acute myocardial infarction revealed high procedural success and low and similar rates of major cardiac adverse events in the 2 groups.
Conclusion:
This study shows that PCI for acute myocardial infarction can be performed safely and effectively in a community hospital without on-site cardiac surgery.
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