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Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup: An Updated Meta-Analysis of
Joo Myung Lee1, Doyeon Hwang1, Jonghanne Park1
1From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.).
Insights
Percutaneous coronary intervention (PCI) outcomes are similar at centers with or without on-site surgery. This applies to both primary PCI for heart attacks and nonprimary PCI, with no significant differences in mortality or complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Emergency coronary artery bypass grafting (CABG) following percutaneous coronary intervention (PCI) is now uncommon.
- The safety and effectiveness of PCI at centers with and without on-site surgical backup require current evaluation.
Purpose of the Study:
- To compare the clinical outcomes and complication rates of primary and nonprimary PCI performed at centers with and without on-site surgical capabilities.
- To assess the impact of on-site surgical backup on patient safety during PCI procedures.
Main Methods:
- An updated systematic review and meta-analysis of 23 high-quality studies involving over 1.1 million patients undergoing PCI.
- Mixed-effects models were used to compare outcomes between centers with and without on-site surgery.
- Analysis included primary PCI for ST-segment-elevation myocardial infarction and nonprimary PCI, examining mortality and emergency CABG rates.
Main Results:
- For primary PCI (133,574 patients), no significant differences in all-cause mortality (OR 0.99) or emergency CABG (OR 0.76) were observed between centers with and without on-site surgery.
- For nonprimary PCI (967,549 patients), all-cause mortality (OR 1.15) and emergency CABG (OR 1.14) rates also did not differ significantly.
- PCI complication rates, including cardiogenic shock, stroke, and recurrent infarction, were comparable across both types of centers.
- A cumulative meta-analysis revealed a temporal decrease in the effect size for all-cause mortality in nonprimary PCI after 2007.
Conclusions:
- PCI demonstrates similar clinical outcomes and complication rates regardless of the presence of on-site surgical backup for both primary and nonprimary procedures.
- Temporal trends indicate ongoing improvements in clinical outcomes for nonprimary PCI, even at centers without on-site surgical support.
Background:
Emergency coronary artery bypass grafting for unsuccessful percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate the current safety and outcomes of primary PCI and nonprimary PCI at centers with and without on-site surgical backup.
Methods And Results:
We performed an updated systematic review and meta-analysis by using mixed-effects models. We included 23 high-quality studies that compared clinical outcomes and complication rates of 1 101 123 patients after PCI at centers with or without on-site surgery. For primary PCI for ST-segment-elevation myocardial infarction (133 574 patients), all-cause mortality (without on-site surgery versus with on-site surgery: observed rates, 4.8% versus 7.2%; pooled odds ratio [OR], 0.99; 95% confidence interval, 0.91-1.07; P=0.729; I(2)=3.4%) or emergency coronary artery bypass grafting rates (observed rates, 1.5% versus 2.4%; pooled OR, 0.76; 95% confidence interval, 0.56-1.01; P=0.062; I(2)=42.5%) did not differ by presence of on-site surgery. For nonprimary PCI (967 549 patients), all-cause mortality (observed rates, 1.6% versus 2.1%; pooled OR, 1.15; 95% confidence interval, 0.94-1.41; P=0.172; I(2)=67.5%) and emergency coronary artery bypass grafting rates (observed rates, 0.5% versus 0.8%; pooled OR, 1.14; 95% confidence interval, 0.62-2.13; P=0.669; I(2)=81.7%) were not significantly different. PCI complication rates (cardiogenic shock, stroke, aortic dissection, tamponade, recurrent infarction) also did not differ by on-site surgical capability. Cumulative meta-analysis of nonprimary PCI showed a temporal decrease of the effect size (OR) for all-cause mortality after 2007.
Conclusions:
Clinical outcomes and complication rates of PCI at centers without on-site surgery did not differ from those with on-site surgery, for both primary and nonprimary PCI. Temporal trends indicated improving clinical outcomes in nonprimary PCI at centers without on-site surgery.
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