Safety and performance of complex percutaneous coronary intervention in centres with and without on-site cardiac...

Contemporary guidelines lack support for the performance of complex percutaneous coronary intervention (PCI) in hospitals with no on-site cardiac surgery (NOSCS). We compared safety and efficacy of complex PCI performed at sites with and without on-site cardiac surgery.

Data from the Victorian Cardiac Outcomes Registry from 2014 and 2022 was retrospectively analysed. Complex PCI was defined as PCI to unprotected left main, bifurcations, rotational atherectomy or intravascular lithotripsy use, severe left ventricular systolic dysfunction, chronic total occlusion, or vein grafts. The primary outcome was 30-day MACCE comprising all-cause mortality, stroke, MI, target vessel revascularisation, and definite/probable stent thrombosis. The secondary outcome was long-term all-cause mortality. Risk ratio was estimated using propensity score analysis.

81,869 PCI procedures were analysed, including 11,710 complex PCI cases (29.0 % at NOSCS). Patients from NOSCS presented more frequently with acute coronary syndromes (NSTE-ACS 35.2 % vs 30.6 %, STEMI 30.0 % vs 19.6 %, p < 0.001). After propensity score adjustment, patients treated at NOSCS centres had equivalent risk of MACCE at 30-days in all-comers PCI (RR 0.95, 95 % CI 0.88-1.03, p = 0.16) and complex PCI (RR 0.97, 95 % CI 0.86-1.10, p = 0.65). There was no difference in propensity-weighted mortality following all-comers or complex at median follow up of 3.5 years.

Patients undergoing PCI and complex PCI at NOSCS centres had comparable risk-adjusted 30-day outcomes and long-term mortality to those treated at OSCS centres. These data underscore the safety of contemporary complex PCI at NOSCS and support health policy changes to increase equitable PCI access for more patients.