Left Main Stem Percutaneous Coronary Intervention: Does On-Site Surgical Cover Make a Difference?

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Nonsurgical centers (NSC) are crucial for percutaneous coronary intervention (PCI) capacity in the UK.
• Previous research indicates comparable PCI outcomes between surgical centers (SC) and NSC.
• The safety and efficacy of complex procedures like left main stem (LMS) PCI in NSC remain less understood.

Purpose of the Study:

• To compare patient characteristics and outcomes of LMS PCI performed in SC versus NSC in England and Wales.
• To evaluate the association between the surgical status of a center and LMS PCI outcomes.
• To assess trends in LMS PCI volume at NSC over time.

Main Methods:

• Retrospective analysis of the British Cardiovascular Intervention Society database (January 2006 - March 2020).
• Stratification of procedures based on the surgical status of the PCI center (SC vs. NSC).
• Assessment of in-hospital major adverse cardiovascular and cerebrovascular events, all-cause mortality, and severe bleeding (BARC 3-5).

Main Results:

• Over 40,000 LMS PCI procedures were analyzed, with 34.2% performed at NSC.
• LMS PCI volume in NSC more than doubled between 2006 and 2020.
• No significant difference in in-hospital mortality, major adverse events, or emergency CABG surgery between SC and NSC.
• NSC demonstrated significantly lower rates of severe bleeding (BARC 3-5).

Conclusions:

• LMS PCI volumes are increasing at NSC, especially for elective procedures.
• Performing LMS PCI at NSC is not associated with increased mortality, major adverse events, or emergency CABG surgery, even with higher disease complexity.
• NSC offer a safe alternative for complex LMS PCI, with the added benefit of reduced bleeding complications.