Related Experiment Video
Updated: Jun 22, 2026
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Outcomes of percutaneous coronary interventions performed at centers without and with onsite coronary artery bypass
David E Wennberg1, F Lee Lucas, Andrea E Siewers
1Center for Outcomes Research and Evaluation, Portland, ME 04101, USA. dwennberg@healthdialog.com
Insights
Percutaneous coronary interventions (PCIs) at hospitals without onsite cardiac surgery led to higher mortality, especially for non-emergency procedures. This suggests caution when expanding PCI access without on-site bypass graft surgery capabilities.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Debate exists on performing percutaneous coronary interventions (PCIs) without onsite coronary artery bypass graft (CABG) surgery.
- This study evaluates patient outcomes at institutions with and without onsite cardiac surgery for PCI procedures.
Purpose of the Study:
- To compare patient outcomes following PCI at US institutions performing this procedure without and with onsite cardiac surgery.
Main Methods:
- Utilized Medicare hospital data (1999-2001) for over 600,000 fee-for-service Medicare enrollees (≥65 years).
- Identified hospitals with and without onsite CABG surgery based on claims.
- Differentiated between primary/rescue PCI (emergency, same-day MI admission) and other PCIs.
Main Results:
- Hospitals without onsite cardiac surgery were more likely to perform primary/rescue PCI (22.0% vs 5.6%).
- Overall mortality was higher in hospitals without onsite cardiac surgery (6.0% vs 3.3%; adjusted OR, 1.29).
- For non-primary/rescue PCI, mortality was significantly higher without onsite cardiac surgery (adjusted OR, 1.38), particularly in lower-volume PCI centers.
Conclusions:
- PCI at hospitals without onsite cardiac surgery is associated with increased adverse outcomes, especially for non-emergency indications.
- Policies promoting PCI access in hospitals without cardiac surgery may increase overall PCI-related mortality.
- Careful consideration of institutional capabilities is crucial for PCI safety and efficacy.
Context:
An ongoing debate focuses on whether institutions should perform percutaneous coronary interventions (PCIs) without an onsite coronary artery bypass graft (CABG) surgery program.
Objective:
To compare patient outcomes following PCI at US institutions performing this procedure without and with onsite cardiac surgery.
Design, Setting, And Patients:
Medicare hospital (part A) data were used to identify PCIs performed on fee-for-service Medicare enrollees (n = 625,854) aged at least 65 years at acute care facilities between January 1, 1999, and December 1, 2001. Hospitals without and with onsite cardiac surgery were identified based on the presence of claims for CABG surgery. Patients were characterized as undergoing primary/rescue PCI, defined as an emergency procedure performed on the same day of admission for an acute myocardial infarction (MI), vs all other PCIs.
Main Outcome Measures:
Post-PCI CABG surgery and combined in-hospital and 30-day mortality.
Results:
A total of 178 hospitals performed PCIs without onsite cardiac surgery and 943 hospitals performed PCIs with onsite cardiac surgery. Patients undergoing PCIs in hospitals without onsite cardiac surgery were similar to those with onsite cardiac surgery with respect to age, sex, race, and measurable comorbidities; however, patients undergoing PCIs in hospitals without onsite cardiac surgery were more likely to have a primary/rescue PCI (22.0% vs 5.6%, P < .001). Patients undergoing PCIs in hospitals without cardiac surgery were more likely to die (6.0% vs 3.3%; adjusted odds ratio [OR], 1.29; 95% confidence interval [CI], 1.14-1.47; P < .001). After accounting for baseline differences, mortality for patients with primary/rescue PCI was similar in institutions without and with cardiac surgery (adjusted OR, 0.93; 95% CI, 0.80-1.08; P = .34). However, for the larger non-primary/rescue PCI population, mortality was higher in hospitals without onsite cardiac surgery (adjusted OR, 1.38; 95% CI, 1.14-1.67; P=.001). This increase in mortality was primarily confined to hospitals performing 50 or less Medicare PCIs per year.
Conclusions:
Percutaneous coronary interventions in hospitals without onsite cardiac surgery are often performed for reasons other than immediate treatment of an MI and are associated with a higher risk of adverse outcomes. Policies aimed at increasing access to primary/rescue PCI through promoting PCI in hospitals without cardiac surgery may inadvertently lead to an overall increase in mortality related to PCI.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management