Are cardiac interventions without onsite surgery worth the risk?

Area of Science:

• Cardiology
• Interventional Cardiology
• Healthcare Policy

Background:

• Coronary Artery Bypass Grafting (CABG) use is declining for failed Percutaneous Coronary Intervention (PCI).
• There is increasing pressure to perform cardiac interventions in facilities without onsite surgical support.
• The Netherlands faces decisions regarding the expansion of PCI centers.

Purpose of the Study:

• To evaluate the necessity and potential consequences of increasing the number of PCI centers in the Netherlands.
• To critically assess the evidence supporting improved patient outcomes with more PCI centers.
• To explore potential driving forces behind the expansion of PCI centers.

Main Methods:

• Review of existing evidence on patient outcomes related to PCI center density.
• Analysis of arguments for and against expanding PCI centers, considering geographical factors.
• Examination of procedural volume, complication rates, and mortality associated with PCI center distribution.

Main Results:

• Evidence supporting improved patient outcomes from increased PCI centers is not robust.
• Geographical arguments like transport time are less relevant in a densely populated country like the Netherlands.
• Expanding PCI centers is likely to decrease procedure volume per center and cardiologist, potentially increasing complications and mortality.

Conclusions:

• Expansion of PCI centers in the Netherlands may lead to worse patient outcomes and increased mortality.
• Reduced procedural volume per center is a significant concern.
• Commercial attractiveness of PCI may be a primary driver for center expansion, rather than patient benefit.