Elective Percutaneous Coronary Intervention in Ambulatory Surgery Centers

Area of Science:

• Cardiology
• Health Services Research

Background:

• Limited data exists on percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs) prior to Medicare reimbursement in 2020.
• Understanding patient characteristics and outcomes in ASCs is crucial for evaluating this care setting.

Purpose of the Study:

• To explore the characteristics and outcomes of patients undergoing elective percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs).
• To compare outcomes between PCI performed in ASCs versus hospital outpatient departments (HOPDs).

Main Methods:

• Analysis of commercial insurance claims (MarketScan) for adults undergoing PCI for stable ischemic heart disease from 2007-2016.
• Utilized propensity score analysis to compare outcomes between ASC and HOPD settings.
• Primary composite outcome included 30-day myocardial infarction, bleeding complications, and hospital admission.

Main Results:

• Patients undergoing ASC PCI were younger, more likely to reside in the southern US, and have specific insurance types.
• ASC PCI was associated with decreased fractional flow reserve utilization.
• In propensity-matched analysis, ASC PCI showed significantly increased odds of bleeding complications (OR: 2.49; 95% CI: 1.25-4.95).

Conclusions:

• Commercially insured patients receiving ASC PCI had lower utilization of fractional flow reserve testing and higher odds of bleeding complications compared to HOPD patients.
• Further investigation is recommended given the increasing volume of Medicare ASC PCI procedures.