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Percutaneous coronary intervention at centers with and without on-site surgery: a meta-analysis
Mandeep Singh1, David R Holmes, Gregory J Dehmer
1Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. singh.mandeep@mayo.edu
JAMA
|December 15, 2011
Summary
Percutaneous coronary interventions (PCI) at centers without onsite surgery show no increased risk of in-hospital mortality or emergency bypass surgery. This systematic review suggests PCI can be safely performed at hospitals without on-site surgical capabilities.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Current guidelines recommend against performing percutaneous coronary interventions (PCI) at centers lacking on-site surgical facilities.
- Despite recommendations, PCI procedures are increasingly performed at hospitals without on-site surgery.
Purpose of the Study:
- To systematically review and compare in-hospital mortality and emergency coronary artery bypass grafting (CABG) surgery rates.
- To assess outcomes of PCI performed at centers with versus without on-site surgical capabilities.
Main Methods:
- A systematic literature search was conducted across MEDLINE, EMBASE, and Cochrane Review databases (January 1990 - May 2010).
- Included were English-language studies reporting in-hospital mortality and emergency bypass rates for PCI at centers with and without on-site surgery.
- Data from 40 selected studies, representing over 1 million patients, were analyzed using random-effects models.
Main Results:
- For primary PCI in ST-segment elevation myocardial infarction (124,074 patients), no significant differences in in-hospital mortality (4.6% vs 7.2%) or emergency bypass (0.22% vs 1.03%) were observed between centers with and without on-site surgery.
- For non-primary PCI (914,288 patients), in-hospital mortality (1.4% vs 2.1%) and emergency bypass rates (0.17% vs 0.29%) were also not significantly different between the two types of centers.
- Quality assessment using the STROBE checklist ensured the inclusion of high-quality observational studies.
Conclusions:
- Percutaneous coronary interventions performed at centers without on-site surgery are not associated with increased in-hospital mortality.
- The incidence of emergency coronary artery bypass grafting surgery is not significantly higher in centers without on-site surgical facilities compared to those with them.
- Findings suggest that PCI can be safely provided at centers without on-site surgical backup.
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